| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,142 |
2,101 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
523 |
261 |
$37K |
| D0330 |
Panoramic radiographic image |
419 |
417 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
652 |
644 |
$22K |
| D1110 |
Prophylaxis - adult |
414 |
413 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
833 |
777 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
249 |
122 |
$5K |
| D0274 |
Bitewings - four radiographic images |
1,533 |
1,500 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
1,899 |
1,864 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
71 |
43 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,110 |
1,096 |
$1K |
| D1351 |
Sealant - per tooth |
231 |
66 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
24 |
$1K |
| D0272 |
Bitewings - two radiographic images |
371 |
368 |
$964.37 |
| D0220 |
Intraoral - periapical first radiographic image |
1,621 |
1,592 |
$667.34 |
| D1330 |
|
2,533 |
2,488 |
$256.22 |
| D1208 |
Topical application of fluoride, excluding varnish |
2,556 |
2,515 |
$182.72 |