| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,226 |
2,005 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,152 |
1,927 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,820 |
1,659 |
$50K |
| D1351 |
Sealant - per tooth |
271 |
166 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
303 |
240 |
$21K |
| D4341 |
|
134 |
70 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
771 |
703 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
409 |
364 |
$10K |
| D0272 |
Bitewings - two radiographic images |
1,103 |
986 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,614 |
1,460 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,292 |
1,158 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
92 |
81 |
$5K |
| D1110 |
Prophylaxis - adult |
71 |
71 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
122 |
117 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
168 |
161 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
84 |
83 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$582.40 |
| D1206 |
Topical application of fluoride varnish |
16 |
16 |
$416.00 |