| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
755 |
755 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
782 |
782 |
$24K |
| D1206 |
Topical application of fluoride varnish |
939 |
939 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
204 |
190 |
$9K |
| D0272 |
Bitewings - two radiographic images |
322 |
322 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
16 |
$5K |
| D1110 |
Prophylaxis - adult |
71 |
71 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
34 |
13 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
217 |
197 |
$4K |
| D1330 |
|
511 |
511 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
65 |
65 |
$4K |
| D0330 |
Panoramic radiographic image |
78 |
78 |
$4K |
| D3120 |
|
70 |
26 |
$2K |
| D1351 |
Sealant - per tooth |
52 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
87 |
84 |
$999.44 |
| D0230 |
Intraoral - periapical each additional radiographic image |
35 |
34 |
$505.12 |