| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,604 |
2,587 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,011 |
440 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,956 |
3,920 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
3,403 |
3,371 |
$61K |
| D1110 |
Prophylaxis - adult |
1,244 |
1,225 |
$51K |
| D0274 |
Bitewings - four radiographic images |
757 |
750 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
349 |
340 |
$10K |
| D0272 |
Bitewings - two radiographic images |
524 |
524 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
285 |
256 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
187 |
79 |
$8K |
| D1351 |
Sealant - per tooth |
163 |
50 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
36 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
159 |
154 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
61 |
59 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
13 |
$698.52 |
| D0330 |
Panoramic radiographic image |
14 |
12 |
$647.88 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
13 |
$0.00 |