| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,855 |
5,461 |
$179K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,372 |
5,027 |
$119K |
| D1351 |
Sealant - per tooth |
4,010 |
795 |
$109K |
| D0240 |
|
8,576 |
2,491 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
3,556 |
2,806 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,096 |
521 |
$65K |
| D1110 |
Prophylaxis - adult |
1,273 |
984 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,555 |
1,350 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,819 |
2,277 |
$50K |
| D0330 |
Panoramic radiographic image |
686 |
538 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
610 |
259 |
$42K |
| D1206 |
Topical application of fluoride varnish |
1,590 |
1,289 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,253 |
954 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,837 |
1,447 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
3,407 |
2,743 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
360 |
206 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
529 |
407 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
253 |
192 |
$8K |
| D9420 |
|
12 |
12 |
$0.00 |