| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,943 |
2,910 |
$231.12 |
| D0274 |
Bitewings - four radiographic images |
2,862 |
2,815 |
$121.66 |
| D1206 |
Topical application of fluoride varnish |
4,174 |
4,068 |
$102.18 |
| D0220 |
Intraoral - periapical first radiographic image |
1,758 |
1,653 |
$25.14 |
| D0330 |
Panoramic radiographic image |
351 |
349 |
$0.00 |
| D1110 |
Prophylaxis - adult |
2,229 |
2,198 |
$0.00 |
| D9996 |
|
858 |
851 |
$0.00 |
| D0270 |
|
368 |
363 |
$0.00 |
| D1354 |
|
305 |
198 |
$0.00 |
| D0191 |
|
1,126 |
1,114 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
358 |
282 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
207 |
192 |
$0.00 |
| D2140 |
|
70 |
53 |
$0.00 |
| D4910 |
|
77 |
77 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
25 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
37 |
26 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
2,754 |
2,695 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
1,730 |
1,707 |
$0.00 |
| D1310 |
|
156 |
154 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
452 |
449 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
625 |
249 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
82 |
59 |
$0.00 |
| D1330 |
|
749 |
722 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
293 |
292 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
346 |
252 |
$0.00 |
| D0602 |
|
451 |
447 |
$0.00 |
| D0603 |
|
118 |
117 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
346 |
327 |
$0.00 |
| D1351 |
Sealant - per tooth |
566 |
171 |
$0.00 |
| D0601 |
|
312 |
308 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$0.00 |
| D2160 |
|
21 |
18 |
$0.00 |
| D2931 |
|
12 |
12 |
$0.00 |