| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,920 |
7,381 |
$187K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,724 |
972 |
$158K |
| D1206 |
Topical application of fluoride varnish |
6,362 |
5,277 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,378 |
3,292 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
5,787 |
3,410 |
$78K |
| D0272 |
Bitewings - two radiographic images |
5,245 |
3,571 |
$60K |
| D0330 |
Panoramic radiographic image |
1,800 |
1,509 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,585 |
1,418 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,764 |
1,410 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,647 |
2,182 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
180 |
147 |
$24K |
| D0145 |
Oral evaluation for a patient under three years of age |
669 |
624 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
265 |
265 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,509 |
1,412 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
312 |
306 |
$12K |
| D1351 |
Sealant - per tooth |
425 |
100 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
86 |
65 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
697 |
560 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
63 |
41 |
$4K |
| D0603 |
|
5,185 |
3,635 |
$0.00 |
| D0602 |
|
39 |
39 |
$0.00 |