| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,595 |
7,594 |
$249K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,720 |
1,874 |
$185K |
| D0120 |
Periodic oral evaluation - established patient |
8,085 |
8,084 |
$179K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,864 |
1,280 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,962 |
6,961 |
$78K |
| D1110 |
Prophylaxis - adult |
1,133 |
1,133 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,887 |
3,871 |
$41K |
| D1206 |
Topical application of fluoride varnish |
1,657 |
1,657 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,942 |
2,939 |
$38K |
| D1351 |
Sealant - per tooth |
751 |
386 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,455 |
3,454 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
395 |
302 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
531 |
531 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
141 |
125 |
$10K |
| D9990 |
|
330 |
326 |
$7K |
| D0274 |
Bitewings - four radiographic images |
301 |
301 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
53 |
53 |
$558.29 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
60 |
56 |
$0.00 |