| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,367 |
2,286 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
2,505 |
2,426 |
$69K |
| D1351 |
Sealant - per tooth |
2,417 |
501 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
654 |
356 |
$41K |
| D1206 |
Topical application of fluoride varnish |
2,864 |
2,768 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,379 |
1,327 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,015 |
893 |
$24K |
| D1110 |
Prophylaxis - adult |
432 |
416 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
214 |
124 |
$18K |
| D0274 |
Bitewings - four radiographic images |
541 |
521 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,679 |
687 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,180 |
1,086 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
192 |
180 |
$6K |
| D0330 |
Panoramic radiographic image |
41 |
37 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
14 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
28 |
$469.50 |
| D0601 |
|
1,331 |
1,297 |
$0.00 |
| D0602 |
|
616 |
608 |
$0.00 |
| D0603 |
|
726 |
708 |
$0.00 |
| D0707 |
|
20 |
20 |
$0.00 |