| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,602 |
1,562 |
$70K |
| D1206 |
Topical application of fluoride varnish |
1,876 |
1,833 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
1,648 |
1,611 |
$41K |
| D9248 |
|
323 |
295 |
$27K |
| D1110 |
Prophylaxis - adult |
324 |
318 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
292 |
108 |
$14K |
| D0272 |
Bitewings - two radiographic images |
739 |
720 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
183 |
75 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
420 |
403 |
$5K |
| D0274 |
Bitewings - four radiographic images |
217 |
210 |
$5K |
| D1351 |
Sealant - per tooth |
171 |
52 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
405 |
344 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
68 |
66 |
$2K |
| D0330 |
Panoramic radiographic image |
45 |
45 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
46 |
44 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
367 |
332 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
43 |
43 |
$897.08 |
| D9420 |
|
17 |
15 |
$627.97 |
| D0703 |
|
52 |
45 |
$488.62 |
| D0601 |
|
476 |
474 |
$440.00 |
| D0602 |
|
115 |
114 |
$112.00 |
| D0603 |
|
28 |
28 |
$26.00 |
| D9986 |
|
32 |
31 |
$0.00 |