| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
4,896 |
4,706 |
$607K |
| D0120 |
Periodic oral evaluation - established patient |
1,968 |
1,883 |
$297K |
| D0140 |
Limited oral evaluation - problem focused |
487 |
456 |
$75K |
| D1351 |
Sealant - per tooth |
1,010 |
199 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
89 |
86 |
$13K |
| D1110 |
Prophylaxis - adult |
376 |
362 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
467 |
388 |
$9K |
| D1120 |
Prophylaxis - child |
935 |
911 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
117 |
44 |
$7K |
| D0272 |
Bitewings - two radiographic images |
797 |
775 |
$4K |
| D0274 |
Bitewings - four radiographic images |
455 |
432 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26 |
17 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
389 |
360 |
$2K |
| D0330 |
Panoramic radiographic image |
234 |
218 |
$832.90 |
| D0230 |
Intraoral - periapical each additional radiographic image |
23 |
12 |
$0.00 |