| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,170 |
2,170 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,560 |
1,959 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,432 |
1,432 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
2,051 |
2,035 |
$37K |
| D1206 |
Topical application of fluoride varnish |
2,054 |
2,054 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,125 |
1,125 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
516 |
481 |
$29K |
| D0274 |
Bitewings - four radiographic images |
517 |
517 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
722 |
722 |
$27K |
| D0330 |
Panoramic radiographic image |
258 |
258 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
230 |
126 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
377 |
371 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
12 |
$1K |
| D9310 |
|
12 |
12 |
$798.72 |