| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,447 |
2,417 |
$135K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,342 |
1,328 |
$39K |
| D1206 |
Topical application of fluoride varnish |
2,468 |
2,445 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,383 |
1,370 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
418 |
236 |
$26K |
| D0330 |
Panoramic radiographic image |
481 |
477 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
581 |
555 |
$19K |
| D0272 |
Bitewings - two radiographic images |
806 |
796 |
$14K |
| D1110 |
Prophylaxis - adult |
209 |
206 |
$11K |
| D1351 |
Sealant - per tooth |
457 |
147 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
141 |
72 |
$7K |
| D0274 |
Bitewings - four radiographic images |
194 |
193 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
340 |
327 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
514 |
483 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
70 |
46 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
37 |
28 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
271 |
190 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$389.40 |
| D9986 |
|
168 |
161 |
$0.00 |