| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,571 |
3,543 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
3,310 |
3,282 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
996 |
510 |
$65K |
| D1206 |
Topical application of fluoride varnish |
3,858 |
3,824 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,076 |
1,067 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
648 |
354 |
$34K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,179 |
1,168 |
$32K |
| D1110 |
Prophylaxis - adult |
651 |
643 |
$23K |
| D1351 |
Sealant - per tooth |
1,047 |
347 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
781 |
701 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,391 |
1,384 |
$15K |
| D1999 |
|
987 |
944 |
$13K |
| D0330 |
Panoramic radiographic image |
333 |
333 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
538 |
519 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
140 |
71 |
$8K |
| D0240 |
|
723 |
367 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
289 |
283 |
$2K |
| D0274 |
Bitewings - four radiographic images |
103 |
103 |
$1K |
| D1354 |
|
122 |
67 |
$437.00 |
| D0601 |
|
1,422 |
1,408 |
$226.00 |
| D0602 |
|
2,305 |
2,290 |
$208.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
42 |
18 |
$90.31 |
| D0603 |
|
394 |
388 |
$76.00 |