| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,294 |
7,147 |
$303K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,159 |
1,207 |
$256K |
| D0120 |
Periodic oral evaluation - established patient |
8,444 |
8,262 |
$237K |
| D1206 |
Topical application of fluoride varnish |
5,332 |
5,239 |
$125K |
| D1110 |
Prophylaxis - adult |
1,361 |
1,323 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,437 |
3,344 |
$75K |
| D0272 |
Bitewings - two radiographic images |
4,202 |
4,097 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,153 |
2,898 |
$57K |
| D0330 |
Panoramic radiographic image |
546 |
530 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
373 |
365 |
$19K |
| D1351 |
Sealant - per tooth |
535 |
134 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
168 |
121 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
61 |
38 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
303 |
295 |
$3K |
| D0274 |
Bitewings - four radiographic images |
120 |
120 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$477.40 |