| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,786 |
4,315 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
745 |
312 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
3,024 |
2,447 |
$60K |
| D0274 |
Bitewings - four radiographic images |
2,998 |
2,212 |
$56K |
| D1351 |
Sealant - per tooth |
2,864 |
317 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,199 |
1,553 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,861 |
1,348 |
$47K |
| D1206 |
Topical application of fluoride varnish |
2,810 |
1,888 |
$37K |
| D0330 |
Panoramic radiographic image |
1,057 |
808 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,013 |
1,736 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
339 |
177 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,759 |
1,271 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
212 |
149 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
37 |
26 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
483 |
209 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
407 |
195 |
$3K |
| D0272 |
Bitewings - two radiographic images |
387 |
186 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
13 |
$1K |
| D0603 |
|
14 |
14 |
$0.00 |
| D0601 |
|
17 |
13 |
$0.00 |