| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,143 |
3,056 |
$98K |
| D1206 |
Topical application of fluoride varnish |
4,708 |
4,569 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
3,477 |
3,381 |
$76K |
| D7140 |
Extraction, erupted tooth or exposed root |
840 |
379 |
$71K |
| D1110 |
Prophylaxis - adult |
1,525 |
1,469 |
$64K |
| D1351 |
Sealant - per tooth |
1,587 |
337 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
1,184 |
1,123 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,026 |
990 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
364 |
204 |
$27K |
| D0330 |
Panoramic radiographic image |
599 |
567 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
315 |
178 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
694 |
675 |
$21K |
| D0272 |
Bitewings - two radiographic images |
678 |
658 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
381 |
358 |
$5K |
| D9999 |
Unspecified adjunctive procedure, by report |
126 |
121 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
87 |
79 |
$2K |
| D9410 |
|
92 |
88 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
78 |
77 |
$1K |
| D9996 |
|
141 |
135 |
$769.60 |
| D0270 |
|
15 |
14 |
$119.46 |
| D1354 |
|
68 |
17 |
$0.00 |