| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,038 |
7,030 |
$290K |
| D0120 |
Periodic oral evaluation - established patient |
8,581 |
8,573 |
$234K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,428 |
7,420 |
$100K |
| D1110 |
Prophylaxis - adult |
1,280 |
1,280 |
$67K |
| D0272 |
Bitewings - two radiographic images |
2,783 |
2,779 |
$44K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
915 |
900 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,437 |
3,433 |
$44K |
| D1351 |
Sealant - per tooth |
861 |
190 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,012 |
1,012 |
$27K |
| D0330 |
Panoramic radiographic image |
732 |
732 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
344 |
275 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
380 |
254 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
39 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
407 |
405 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
118 |
118 |
$2K |
| D0240 |
|
76 |
40 |
$1K |