| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,818 |
3,690 |
$174K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,181 |
5,020 |
$128K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,893 |
1,245 |
$123K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,261 |
4,121 |
$60K |
| D1110 |
Prophylaxis - adult |
1,362 |
1,324 |
$60K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,446 |
1,204 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
513 |
387 |
$41K |
| D0272 |
Bitewings - two radiographic images |
2,213 |
2,139 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
525 |
407 |
$28K |
| D0330 |
Panoramic radiographic image |
695 |
661 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
514 |
381 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,745 |
1,694 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,720 |
1,670 |
$13K |
| D2332 |
|
32 |
24 |
$2K |
| D9986 |
|
578 |
494 |
$0.00 |