| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,656 |
3,596 |
$137K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,573 |
887 |
$89K |
| D1110 |
Prophylaxis - adult |
1,253 |
1,217 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
840 |
829 |
$40K |
| D0330 |
Panoramic radiographic image |
415 |
403 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
463 |
322 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
4,053 |
3,968 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
215 |
151 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,440 |
1,165 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
115 |
85 |
$5K |
| D1330 |
|
4,841 |
4,749 |
$5K |
| D1351 |
Sealant - per tooth |
1,922 |
608 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,893 |
4,796 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,913 |
1,663 |
$1K |
| D0272 |
Bitewings - two radiographic images |
2,273 |
2,235 |
$956.85 |
| D0140 |
Limited oral evaluation - problem focused |
62 |
61 |
$560.49 |
| D0220 |
Intraoral - periapical first radiographic image |
2,300 |
2,160 |
$513.82 |
| D1354 |
|
792 |
269 |
$480.36 |
| D0274 |
Bitewings - four radiographic images |
880 |
857 |
$332.28 |