| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
845 |
834 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,039 |
1,017 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
853 |
835 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
563 |
547 |
$7K |
| D0272 |
Bitewings - two radiographic images |
339 |
334 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
39 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
486 |
460 |
$4K |
| D1110 |
Prophylaxis - adult |
111 |
106 |
$4K |
| D1351 |
Sealant - per tooth |
142 |
41 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
100 |
92 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
64 |
62 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
12 |
$2K |
| D9248 |
|
12 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
17 |
17 |
$494.16 |
| D1999 |
|
42 |
40 |
$0.00 |