| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,673 |
3,633 |
$167K |
| D0120 |
Periodic oral evaluation - established patient |
2,976 |
2,946 |
$91K |
| D1206 |
Topical application of fluoride varnish |
2,676 |
2,653 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
804 |
798 |
$43K |
| D0272 |
Bitewings - two radiographic images |
2,144 |
2,121 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
243 |
163 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,218 |
1,199 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
855 |
785 |
$16K |
| D1351 |
Sealant - per tooth |
213 |
39 |
$8K |
| D1110 |
Prophylaxis - adult |
106 |
105 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
126 |
124 |
$6K |
| D1330 |
|
734 |
732 |
$5K |
| D0274 |
Bitewings - four radiographic images |
150 |
150 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
42 |
42 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
14 |
$2K |
| D3120 |
|
13 |
12 |
$455.00 |