| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,824 |
3,761 |
$120K |
| D0120 |
Periodic oral evaluation - established patient |
5,883 |
5,792 |
$109K |
| D1206 |
Topical application of fluoride varnish |
5,554 |
5,516 |
$108K |
| D1110 |
Prophylaxis - adult |
1,337 |
1,317 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
546 |
386 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
822 |
273 |
$35K |
| D0274 |
Bitewings - four radiographic images |
862 |
853 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
120 |
104 |
$9K |
| D0272 |
Bitewings - two radiographic images |
279 |
270 |
$5K |
| D0330 |
Panoramic radiographic image |
71 |
50 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
108 |
89 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
60 |
59 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
25 |
$976.50 |
| D0220 |
Intraoral - periapical first radiographic image |
104 |
86 |
$923.17 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
13 |
$650.53 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
13 |
$60.00 |