| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
698 |
687 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
1,213 |
1,176 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
328 |
194 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
848 |
814 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
195 |
79 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
402 |
387 |
$9K |
| D1120 |
Prophylaxis - child |
370 |
345 |
$7K |
| D0274 |
Bitewings - four radiographic images |
217 |
216 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
164 |
153 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
26 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
377 |
366 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
100 |
89 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
24 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
51 |
51 |
$983.35 |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$326.15 |
| D1351 |
Sealant - per tooth |
53 |
13 |
$0.00 |