| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,976 |
9,793 |
$328K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,163 |
1,992 |
$290K |
| D0120 |
Periodic oral evaluation - established patient |
10,712 |
10,527 |
$238K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,904 |
9,723 |
$162K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,440 |
1,284 |
$155K |
| D0330 |
Panoramic radiographic image |
2,463 |
2,406 |
$142K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,022 |
4,696 |
$128K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,534 |
1,112 |
$109K |
| D0272 |
Bitewings - two radiographic images |
4,261 |
4,169 |
$87K |
| D1110 |
Prophylaxis - adult |
1,933 |
1,907 |
$84K |
| D1206 |
Topical application of fluoride varnish |
2,009 |
1,978 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,460 |
1,423 |
$54K |
| D1354 |
|
852 |
317 |
$40K |
| D1351 |
Sealant - per tooth |
468 |
110 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
325 |
308 |
$11K |
| D0274 |
Bitewings - four radiographic images |
383 |
374 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
515 |
503 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$2K |
| D1330 |
|
12 |
12 |
$0.00 |