| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,196 |
10,117 |
$297K |
| D1206 |
Topical application of fluoride varnish |
13,226 |
13,125 |
$238K |
| D0120 |
Periodic oral evaluation - established patient |
12,062 |
11,971 |
$209K |
| D1110 |
Prophylaxis - adult |
2,847 |
2,826 |
$113K |
| D0272 |
Bitewings - two radiographic images |
3,954 |
3,925 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,081 |
1,999 |
$60K |
| D0274 |
Bitewings - four radiographic images |
1,696 |
1,678 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
516 |
281 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,998 |
2,924 |
$30K |
| D1351 |
Sealant - per tooth |
673 |
194 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,379 |
1,020 |
$15K |
| D0330 |
Panoramic radiographic image |
249 |
248 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
403 |
403 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
25 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
37 |
$807.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$0.00 |