| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,382 |
3,323 |
$162K |
| D1110 |
Prophylaxis - adult |
1,031 |
1,013 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
712 |
437 |
$31K |
| D0330 |
Panoramic radiographic image |
181 |
178 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
4,402 |
4,321 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
143 |
112 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,319 |
4,238 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
135 |
90 |
$6K |
| D0272 |
Bitewings - two radiographic images |
2,604 |
2,547 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
546 |
504 |
$5K |
| D1330 |
|
4,580 |
4,496 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
4,005 |
3,630 |
$3K |
| D1351 |
Sealant - per tooth |
815 |
238 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,726 |
3,381 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
260 |
248 |
$2K |
| D0274 |
Bitewings - four radiographic images |
976 |
958 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$615.64 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$523.00 |