| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,953 |
1,940 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,027 |
2,014 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,224 |
2,205 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,399 |
2,185 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,154 |
1,147 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
425 |
293 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,337 |
2,311 |
$29K |
| D1110 |
Prophylaxis - adult |
647 |
641 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,080 |
1,070 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
592 |
571 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
589 |
583 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
188 |
127 |
$11K |
| D1351 |
Sealant - per tooth |
328 |
105 |
$9K |
| D1206 |
Topical application of fluoride varnish |
212 |
212 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
25 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
38 |
37 |
$927.20 |
| D1330 |
|
2,579 |
2,560 |
$0.00 |