| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,220 |
3,041 |
$129K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,051 |
2,865 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,487 |
3,275 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,074 |
960 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
483 |
299 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,644 |
1,565 |
$23K |
| D1110 |
Prophylaxis - adult |
556 |
488 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
1,123 |
1,045 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
218 |
124 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
133 |
130 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
451 |
425 |
$4K |
| D0330 |
Panoramic radiographic image |
72 |
60 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27 |
25 |
$168.90 |
| D1999 |
|
88 |
79 |
$0.00 |