| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,841 |
2,799 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
958 |
554 |
$66K |
| D1206 |
Topical application of fluoride varnish |
3,335 |
3,280 |
$65K |
| D1351 |
Sealant - per tooth |
2,332 |
657 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
2,372 |
2,329 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
614 |
391 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,343 |
1,242 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
699 |
694 |
$18K |
| D9920 |
|
486 |
449 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,083 |
1,073 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
186 |
113 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,232 |
1,194 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,023 |
838 |
$7K |
| D1110 |
Prophylaxis - adult |
265 |
264 |
$6K |
| D0603 |
|
496 |
496 |
$5K |
| D1353 |
|
488 |
126 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
138 |
116 |
$5K |
| D0240 |
|
569 |
296 |
$4K |
| D0601 |
|
302 |
302 |
$3K |
| D0274 |
Bitewings - four radiographic images |
225 |
225 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
103 |
101 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
42 |
42 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$842.28 |
| D0602 |
|
50 |
50 |
$500.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
17 |
17 |
$361.25 |