| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
219 |
219 |
$9K |
| D1351 |
Sealant - per tooth |
141 |
72 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
233 |
233 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
89 |
88 |
$6K |
| D1354 |
|
227 |
139 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
211 |
211 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
206 |
206 |
$5K |
| D0274 |
Bitewings - four radiographic images |
228 |
228 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
39 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
199 |
198 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
504 |
500 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
391 |
389 |
$2K |
| D0330 |
Panoramic radiographic image |
91 |
91 |
$2K |
| D0272 |
Bitewings - two radiographic images |
122 |
122 |
$1K |
| D1110 |
Prophylaxis - adult |
35 |
35 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$509.60 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$432.77 |