| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,771 |
4,693 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
4,822 |
4,738 |
$100K |
| D1206 |
Topical application of fluoride varnish |
5,596 |
5,485 |
$84K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
610 |
294 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,172 |
2,114 |
$32K |
| D0350 |
|
3,235 |
2,002 |
$29K |
| D0330 |
Panoramic radiographic image |
698 |
684 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
380 |
192 |
$23K |
| D1110 |
Prophylaxis - adult |
548 |
537 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
879 |
851 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,721 |
1,670 |
$16K |
| D0274 |
Bitewings - four radiographic images |
599 |
587 |
$15K |
| D1351 |
Sealant - per tooth |
643 |
208 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,418 |
1,145 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
456 |
441 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
68 |
38 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
36 |
36 |
$994.20 |
| D1321 |
|
30 |
27 |
$364.64 |
| D1330 |
|
742 |
675 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
29 |
$0.00 |