| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,941 |
2,766 |
$84K |
| D1351 |
Sealant - per tooth |
2,933 |
536 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,026 |
567 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,820 |
1,713 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,454 |
1,193 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,735 |
2,537 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
771 |
712 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,607 |
1,498 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,136 |
2,459 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,465 |
1,362 |
$13K |
| D1206 |
Topical application of fluoride varnish |
1,150 |
1,101 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
551 |
300 |
$11K |
| D0274 |
Bitewings - four radiographic images |
433 |
403 |
$8K |
| D0603 |
|
1,530 |
1,431 |
$4K |
| D0999 |
Unspecified diagnostic procedure, by report |
136 |
136 |
$4K |
| D0350 |
|
525 |
492 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
131 |
73 |
$401.72 |
| D0140 |
Limited oral evaluation - problem focused |
65 |
54 |
$232.68 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$63.55 |