| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,558 |
4,211 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
4,373 |
4,075 |
$15K |
| D1206 |
Topical application of fluoride varnish |
5,222 |
4,820 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
294 |
144 |
$8K |
| D0272 |
Bitewings - two radiographic images |
2,230 |
2,058 |
$7K |
| D1351 |
Sealant - per tooth |
782 |
246 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
1,905 |
1,749 |
$4K |
| D0274 |
Bitewings - four radiographic images |
979 |
890 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,887 |
1,370 |
$4K |
| D1110 |
Prophylaxis - adult |
357 |
308 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
606 |
558 |
$3K |
| D0330 |
Panoramic radiographic image |
209 |
196 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
391 |
317 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
158 |
91 |
$2K |
| D0240 |
|
840 |
577 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
56 |
54 |
$837.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
66 |
66 |
$620.08 |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
13 |
$402.32 |
| D1354 |
|
54 |
19 |
$226.46 |
| D1208 |
Topical application of fluoride, excluding varnish |
19 |
19 |
$65.92 |
| D0431 |
|
2,698 |
2,113 |
$28.80 |
| D0210 |
Intraoral - complete series of radiographic images |
65 |
65 |
$0.00 |