| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,880 |
2,741 |
$121K |
| D1206 |
Topical application of fluoride varnish |
2,784 |
2,650 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
771 |
430 |
$73K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,074 |
886 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,858 |
1,773 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
807 |
770 |
$49K |
| D0272 |
Bitewings - two radiographic images |
519 |
496 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
292 |
267 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
151 |
105 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
14 |
$3K |
| D0274 |
Bitewings - four radiographic images |
55 |
53 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$242.06 |
| D9911 |
|
589 |
283 |
$0.00 |