| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,904 |
3,824 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
3,468 |
3,404 |
$18K |
| D1206 |
Topical application of fluoride varnish |
4,252 |
4,172 |
$18K |
| D0272 |
Bitewings - two radiographic images |
2,344 |
2,290 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
3,084 |
2,978 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,020 |
2,760 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
654 |
272 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
575 |
565 |
$5K |
| D1110 |
Prophylaxis - adult |
263 |
256 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
631 |
604 |
$2K |
| D0330 |
Panoramic radiographic image |
341 |
339 |
$2K |
| D0274 |
Bitewings - four radiographic images |
202 |
198 |
$1K |
| D0350 |
|
342 |
107 |
$656.58 |
| D1351 |
Sealant - per tooth |
102 |
29 |
$511.14 |
| D1208 |
Topical application of fluoride, excluding varnish |
127 |
125 |
$398.25 |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
16 |
$394.15 |
| D1330 |
|
1,659 |
1,553 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
28 |
$0.00 |
| D0601 |
|
13 |
12 |
$0.00 |