| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,286 |
8,668 |
$260K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,480 |
5,101 |
$199K |
| D1206 |
Topical application of fluoride varnish |
5,913 |
5,001 |
$129K |
| D1351 |
Sealant - per tooth |
4,911 |
1,106 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
4,045 |
3,787 |
$102K |
| D0272 |
Bitewings - two radiographic images |
4,332 |
3,591 |
$74K |
| D0330 |
Panoramic radiographic image |
1,544 |
1,363 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,230 |
3,573 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
921 |
476 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
459 |
300 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,546 |
1,307 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,070 |
959 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,361 |
1,180 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
102 |
48 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
70 |
70 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
50 |
45 |
$2K |
| D9310 |
|
60 |
27 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
87 |
50 |
$688.46 |
| D0603 |
|
19 |
19 |
$0.00 |
| D1999 |
|
30 |
28 |
$0.00 |