| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,625 |
6,468 |
$273K |
| D1206 |
Topical application of fluoride varnish |
6,600 |
6,440 |
$172K |
| D0120 |
Periodic oral evaluation - established patient |
5,578 |
5,436 |
$157K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
928 |
752 |
$61K |
| D0274 |
Bitewings - four radiographic images |
1,747 |
1,706 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
646 |
525 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,114 |
1,087 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
4,018 |
3,897 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,759 |
3,548 |
$19K |
| D1351 |
Sealant - per tooth |
256 |
151 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,525 |
1,482 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
243 |
236 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
321 |
308 |
$5K |
| D1110 |
Prophylaxis - adult |
120 |
118 |
$3K |
| D0330 |
Panoramic radiographic image |
57 |
56 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
84 |
84 |
$793.80 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$754.65 |
| D9310 |
|
16 |
16 |
$273.60 |
| D1999 |
|
646 |
525 |
$0.00 |