| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,598 |
2,557 |
$119K |
| D1110 |
Prophylaxis - adult |
1,007 |
990 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
3,243 |
3,192 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
267 |
187 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
145 |
145 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
275 |
275 |
$14K |
| D0330 |
Panoramic radiographic image |
116 |
116 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,490 |
3,432 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
2,267 |
2,204 |
$7K |
| D1330 |
|
3,497 |
3,438 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,808 |
1,753 |
$4K |
| D0272 |
Bitewings - two radiographic images |
1,380 |
1,358 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
315 |
298 |
$3K |
| D0274 |
Bitewings - four radiographic images |
938 |
921 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
17 |
$3K |
| D1351 |
Sealant - per tooth |
361 |
107 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$317.62 |
| D3120 |
|
21 |
18 |
$0.00 |