| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,512 |
1,498 |
$59K |
| D1120 |
Prophylaxis - child |
2,382 |
2,366 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,073 |
1,392 |
$16K |
| D1206 |
Topical application of fluoride varnish |
2,531 |
2,505 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
1,060 |
1,054 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
273 |
224 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
149 |
93 |
$5K |
| D1330 |
|
2,595 |
2,573 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
1,703 |
1,654 |
$3K |
| D0272 |
Bitewings - two radiographic images |
378 |
371 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
104 |
41 |
$1K |
| D1351 |
Sealant - per tooth |
145 |
39 |
$782.20 |
| D0240 |
|
55 |
54 |
$420.44 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
12 |
$106.52 |
| D1354 |
|
29 |
12 |
$82.58 |
| D1310 |
|
104 |
104 |
$0.00 |
| D9986 |
|
18 |
13 |
$0.00 |