| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,068 |
3,039 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
1,565 |
1,555 |
$109K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,018 |
2,993 |
$63K |
| D1310 |
|
1,373 |
1,356 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
863 |
853 |
$60K |
| D1351 |
Sealant - per tooth |
1,039 |
289 |
$38K |
| D9430 |
|
770 |
681 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
589 |
572 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,472 |
1,453 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
263 |
129 |
$17K |
| D0603 |
|
1,123 |
1,111 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
236 |
232 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,021 |
1,673 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
818 |
774 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
25 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
14 |
$1K |
| D0602 |
|
28 |
28 |
$420.00 |
| D0601 |
|
18 |
18 |
$195.00 |