| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,278 |
2,266 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
2,496 |
2,478 |
$96K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
839 |
571 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
816 |
539 |
$64K |
| D1351 |
Sealant - per tooth |
1,444 |
308 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,911 |
1,906 |
$45K |
| D1206 |
Topical application of fluoride varnish |
968 |
957 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,389 |
2,345 |
$25K |
| D0272 |
Bitewings - two radiographic images |
807 |
806 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,177 |
1,161 |
$24K |
| D1110 |
Prophylaxis - adult |
555 |
541 |
$21K |
| D9920 |
|
399 |
359 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,965 |
1,946 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
86 |
58 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
213 |
211 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
249 |
235 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
31 |
18 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
61 |
59 |
$2K |
| D0601 |
|
12 |
12 |
$110.00 |
| D0602 |
|
12 |
12 |
$110.00 |