| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,603 |
8,603 |
$406K |
| D0120 |
Periodic oral evaluation - established patient |
9,318 |
9,317 |
$297K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,722 |
1,200 |
$201K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,382 |
6,382 |
$98K |
| D1206 |
Topical application of fluoride varnish |
2,782 |
2,782 |
$92K |
| D1110 |
Prophylaxis - adult |
1,339 |
1,339 |
$85K |
| D0272 |
Bitewings - two radiographic images |
3,943 |
3,943 |
$74K |
| D1351 |
Sealant - per tooth |
659 |
300 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
1,556 |
1,548 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
332 |
266 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
591 |
591 |
$20K |
| D0240 |
|
386 |
383 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
132 |
116 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
706 |
668 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
678 |
678 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
235 |
230 |
$4K |
| D0274 |
Bitewings - four radiographic images |
40 |
40 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$397.80 |
| D1999 |
|
228 |
223 |
$0.00 |