| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,497 |
2,482 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,709 |
2,695 |
$62K |
| D1206 |
Topical application of fluoride varnish |
2,447 |
2,431 |
$53K |
| D1110 |
Prophylaxis - adult |
688 |
687 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,117 |
1,105 |
$21K |
| D1330 |
|
2,883 |
2,866 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
304 |
196 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
882 |
877 |
$15K |
| D1310 |
|
2,175 |
2,162 |
$15K |
| D0603 |
|
1,365 |
1,359 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
529 |
524 |
$12K |
| D0274 |
Bitewings - four radiographic images |
232 |
232 |
$8K |
| D0330 |
Panoramic radiographic image |
164 |
164 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
115 |
85 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
152 |
144 |
$5K |
| D0602 |
|
179 |
179 |
$2K |
| D1354 |
|
89 |
51 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
13 |
$1K |
| D0240 |
|
44 |
39 |
$958.13 |
| D0220 |
Intraoral - periapical first radiographic image |
42 |
42 |
$410.38 |
| D0601 |
|
30 |
30 |
$295.00 |