| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,560 |
1,310 |
$215K |
| D1120 |
Prophylaxis - child |
3,284 |
3,283 |
$120K |
| D0120 |
Periodic oral evaluation - established patient |
3,606 |
3,604 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,687 |
2,686 |
$33K |
| D2394 |
|
214 |
164 |
$27K |
| D1110 |
Prophylaxis - adult |
517 |
517 |
$26K |
| D1351 |
Sealant - per tooth |
714 |
191 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
216 |
171 |
$21K |
| D0272 |
Bitewings - two radiographic images |
771 |
770 |
$15K |
| D1206 |
Topical application of fluoride varnish |
957 |
957 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
192 |
135 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
772 |
762 |
$11K |
| D0330 |
Panoramic radiographic image |
187 |
187 |
$9K |
| D0274 |
Bitewings - four radiographic images |
198 |
198 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
250 |
250 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
124 |
123 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
12 |
$740.96 |
| D9215 |
|
44 |
42 |
$0.00 |
| D1999 |
|
720 |
672 |
$0.00 |