| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,633 |
4,622 |
$178K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,548 |
1,544 |
$77K |
| D9920 |
|
709 |
706 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
696 |
478 |
$59K |
| D1206 |
Topical application of fluoride varnish |
5,210 |
5,198 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,294 |
4,369 |
$34K |
| D1110 |
Prophylaxis - adult |
482 |
481 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
3,670 |
3,660 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
444 |
313 |
$21K |
| D1351 |
Sealant - per tooth |
2,319 |
684 |
$19K |
| D0330 |
Panoramic radiographic image |
256 |
256 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,110 |
1,026 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
468 |
284 |
$19K |
| D1330 |
|
5,262 |
5,251 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
4,850 |
4,811 |
$9K |
| D0272 |
Bitewings - two radiographic images |
1,368 |
1,363 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
204 |
199 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
87 |
87 |
$2K |
| D0274 |
Bitewings - four radiographic images |
470 |
469 |
$2K |
| D0601 |
|
3,411 |
3,405 |
$2K |
| D0603 |
|
814 |
812 |
$550.00 |
| D0602 |
|
409 |
407 |
$200.46 |
| D1310 |
|
3,462 |
3,459 |
$0.00 |