| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,139 |
4,128 |
$175K |
| D1206 |
Topical application of fluoride varnish |
4,223 |
4,209 |
$129K |
| D1351 |
Sealant - per tooth |
5,361 |
1,391 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
3,990 |
3,978 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,230 |
679 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
818 |
528 |
$44K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,558 |
1,504 |
$38K |
| D1353 |
|
2,458 |
560 |
$22K |
| D0603 |
|
2,016 |
2,002 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,609 |
1,606 |
$16K |
| D1110 |
Prophylaxis - adult |
412 |
411 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,740 |
2,728 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,455 |
2,430 |
$12K |
| D9920 |
|
444 |
430 |
$11K |
| D0274 |
Bitewings - four radiographic images |
711 |
710 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
155 |
155 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
27 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
71 |
71 |
$2K |
| D0602 |
|
175 |
175 |
$2K |
| D0601 |
|
188 |
187 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$630.00 |
| D0270 |
|
41 |
41 |
$200.00 |