| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,826 |
5,806 |
$255K |
| D0120 |
Periodic oral evaluation - established patient |
6,835 |
6,763 |
$204K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,522 |
7,448 |
$188K |
| D0274 |
Bitewings - four radiographic images |
2,935 |
2,898 |
$108K |
| D2332 |
|
616 |
345 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
896 |
545 |
$86K |
| D1110 |
Prophylaxis - adult |
1,923 |
1,868 |
$62K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
372 |
252 |
$44K |
| D0330 |
Panoramic radiographic image |
488 |
487 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
361 |
231 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
475 |
456 |
$24K |
| D0272 |
Bitewings - two radiographic images |
776 |
772 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
196 |
123 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
425 |
404 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
274 |
272 |
$16K |
| D1351 |
Sealant - per tooth |
393 |
138 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,035 |
1,018 |
$15K |
| D2394 |
|
55 |
39 |
$9K |
| D2335 |
|
17 |
12 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
133 |
130 |
$2K |