| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,525 |
3,507 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
860 |
478 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
3,984 |
3,963 |
$67K |
| D1206 |
Topical application of fluoride varnish |
3,258 |
3,240 |
$55K |
| D1110 |
Prophylaxis - adult |
1,167 |
1,161 |
$48K |
| D9630 |
|
2,425 |
2,404 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,359 |
1,144 |
$39K |
| D9920 |
|
686 |
580 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,235 |
1,231 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,022 |
1,016 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
212 |
105 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
292 |
149 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,807 |
989 |
$13K |
| D0274 |
Bitewings - four radiographic images |
466 |
464 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
326 |
326 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,311 |
1,297 |
$10K |
| D1351 |
Sealant - per tooth |
195 |
66 |
$7K |
| D0330 |
Panoramic radiographic image |
57 |
56 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
24 |
$0.00 |