| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,353 |
5,229 |
$265K |
| D0120 |
Periodic oral evaluation - established patient |
5,754 |
5,559 |
$161K |
| D1206 |
Topical application of fluoride varnish |
5,786 |
5,646 |
$147K |
| D9450 |
|
3,430 |
3,008 |
$56K |
| D0272 |
Bitewings - two radiographic images |
1,749 |
1,705 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
462 |
324 |
$51K |
| D1351 |
Sealant - per tooth |
896 |
276 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,514 |
1,360 |
$29K |
| D1110 |
Prophylaxis - adult |
495 |
448 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
338 |
328 |
$18K |
| D0274 |
Bitewings - four radiographic images |
429 |
399 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
128 |
79 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
348 |
344 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
95 |
55 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
131 |
129 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
26 |
$4K |
| D0330 |
Panoramic radiographic image |
42 |
42 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
122 |
114 |
$2K |
| D1330 |
|
37 |
37 |
$0.00 |