| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,428 |
2,199 |
$64K |
| D1206 |
Topical application of fluoride varnish |
2,418 |
2,136 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,643 |
1,410 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,519 |
1,436 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
439 |
259 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,234 |
1,016 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
267 |
177 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,258 |
1,114 |
$21K |
| D0330 |
Panoramic radiographic image |
423 |
379 |
$18K |
| D1999 |
|
953 |
749 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
657 |
629 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
664 |
580 |
$6K |
| D1110 |
Prophylaxis - adult |
135 |
130 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
80 |
78 |
$2K |
| D0240 |
|
119 |
41 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
15 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
132 |
70 |
$1K |
| D1351 |
Sealant - per tooth |
45 |
12 |
$572.00 |