| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,808 |
3,725 |
$65K |
| D1206 |
Topical application of fluoride varnish |
4,233 |
4,148 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
2,951 |
2,906 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,392 |
3,070 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,543 |
1,486 |
$28K |
| D0272 |
Bitewings - two radiographic images |
2,321 |
2,277 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
3,425 |
3,308 |
$20K |
| D1351 |
Sealant - per tooth |
1,604 |
483 |
$20K |
| D0330 |
Panoramic radiographic image |
758 |
728 |
$20K |
| D1110 |
Prophylaxis - adult |
564 |
560 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
294 |
181 |
$12K |
| D0274 |
Bitewings - four radiographic images |
566 |
559 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
253 |
140 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
688 |
617 |
$8K |
| D0350 |
|
628 |
561 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
82 |
39 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
25 |
$496.34 |
| D1330 |
|
2,064 |
1,711 |
$0.00 |