| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,635 |
1,633 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
1,877 |
1,875 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,496 |
1,494 |
$41K |
| D4341 |
|
219 |
134 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
387 |
317 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,001 |
998 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
177 |
143 |
$17K |
| D1110 |
Prophylaxis - adult |
335 |
335 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
546 |
544 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,912 |
1,875 |
$12K |
| D1351 |
Sealant - per tooth |
147 |
83 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
211 |
185 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
469 |
465 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,474 |
1,459 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
292 |
285 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
34 |
32 |
$2K |
| D0272 |
Bitewings - two radiographic images |
208 |
208 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
94 |
94 |
$2K |
| D1206 |
Topical application of fluoride varnish |
51 |
51 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
15 |
$1K |
| D4910 |
|
12 |
12 |
$804.00 |