| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
2,521 |
360 |
$57K |
| D1120 |
Prophylaxis - child |
1,132 |
1,091 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,595 |
1,514 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,511 |
1,447 |
$25K |
| D1110 |
Prophylaxis - adult |
516 |
479 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
238 |
125 |
$15K |
| D2394 |
|
154 |
53 |
$14K |
| D0274 |
Bitewings - four radiographic images |
500 |
469 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
309 |
248 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
13 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
38 |
$3K |
| D0272 |
Bitewings - two radiographic images |
120 |
115 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
84 |
72 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
36 |
35 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
63 |
53 |
$581.70 |