| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,421 |
3,338 |
$174K |
| D0120 |
Periodic oral evaluation - established patient |
6,762 |
6,706 |
$171K |
| D1206 |
Topical application of fluoride varnish |
8,116 |
8,011 |
$168K |
| D1120 |
Prophylaxis - child |
4,317 |
4,292 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
525 |
295 |
$67K |
| D0274 |
Bitewings - four radiographic images |
1,868 |
1,842 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,091 |
1,080 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,159 |
1,133 |
$36K |
| D0330 |
Panoramic radiographic image |
598 |
595 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,253 |
1,243 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
149 |
76 |
$14K |
| D1351 |
Sealant - per tooth |
359 |
95 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
835 |
812 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
49 |
30 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
214 |
207 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
135 |
130 |
$5K |
| D0240 |
|
14 |
14 |
$530.32 |