| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,285 |
4,218 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
4,352 |
4,262 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
645 |
229 |
$16K |
| D1206 |
Topical application of fluoride varnish |
4,745 |
4,647 |
$16K |
| D0272 |
Bitewings - two radiographic images |
2,223 |
2,171 |
$8K |
| D1110 |
Prophylaxis - adult |
231 |
224 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
128 |
125 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
13 |
$1K |
| D0240 |
|
288 |
155 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
246 |
233 |
$1K |
| D1351 |
Sealant - per tooth |
101 |
29 |
$805.38 |
| D0140 |
Limited oral evaluation - problem focused |
82 |
77 |
$757.68 |
| D0330 |
Panoramic radiographic image |
51 |
50 |
$680.49 |
| D0220 |
Intraoral - periapical first radiographic image |
130 |
116 |
$416.64 |
| D0274 |
Bitewings - four radiographic images |
31 |
30 |
$239.92 |
| D1999 |
|
763 |
714 |
$0.00 |