| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,861 |
1,861 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
1,844 |
1,844 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
774 |
517 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,016 |
1,016 |
$30K |
| D1206 |
Topical application of fluoride varnish |
836 |
836 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
573 |
509 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,303 |
1,303 |
$13K |
| D1351 |
Sealant - per tooth |
335 |
108 |
$7K |
| D0603 |
|
599 |
599 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
977 |
970 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
88 |
67 |
$5K |
| D0274 |
Bitewings - four radiographic images |
309 |
309 |
$4K |
| D0602 |
|
351 |
351 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
65 |
41 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
740 |
737 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
63 |
63 |
$2K |
| D0601 |
|
13 |
13 |
$130.00 |