| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,898 |
3,733 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
5,111 |
4,901 |
$91K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,431 |
786 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,107 |
569 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,323 |
5,098 |
$67K |
| D0274 |
Bitewings - four radiographic images |
3,467 |
3,325 |
$66K |
| D1110 |
Prophylaxis - adult |
1,727 |
1,661 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,601 |
1,271 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,133 |
2,010 |
$20K |
| D0330 |
Panoramic radiographic image |
567 |
550 |
$17K |
| D0272 |
Bitewings - two radiographic images |
937 |
886 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
359 |
359 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
323 |
294 |
$8K |
| D1351 |
Sealant - per tooth |
199 |
54 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
79 |
76 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
153 |
140 |
$2K |
| D1206 |
Topical application of fluoride varnish |
161 |
159 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
14 |
$1K |
| D1999 |
|
1,071 |
911 |
$0.00 |