| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,680 |
1,629 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
1,414 |
1,373 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,480 |
1,436 |
$37K |
| D1351 |
Sealant - per tooth |
504 |
309 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
293 |
231 |
$19K |
| D0274 |
Bitewings - four radiographic images |
565 |
548 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,656 |
1,594 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,513 |
1,454 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
147 |
128 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
106 |
89 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
191 |
172 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
209 |
201 |
$4K |
| D0272 |
Bitewings - two radiographic images |
434 |
419 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
38 |
$599.40 |
| D0210 |
Intraoral - complete series of radiographic images |
38 |
37 |
$598.60 |
| D0330 |
Panoramic radiographic image |
14 |
13 |
$180.80 |