| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,956 |
1,914 |
$94K |
| D1110 |
Prophylaxis - adult |
1,906 |
1,845 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,334 |
3,236 |
$83K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,060 |
730 |
$62K |
| D0274 |
Bitewings - four radiographic images |
1,986 |
1,915 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,461 |
3,377 |
$52K |
| D0330 |
Panoramic radiographic image |
1,230 |
1,192 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
530 |
378 |
$23K |
| D1351 |
Sealant - per tooth |
1,212 |
375 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
619 |
614 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,569 |
1,502 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,137 |
1,077 |
$9K |
| D0272 |
Bitewings - two radiographic images |
428 |
422 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
132 |
119 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
135 |
134 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
12 |
$982.68 |
| D2332 |
|
15 |
13 |
$799.14 |
| D1330 |
|
43 |
43 |
$424.27 |
| D1999 |
|
403 |
347 |
$0.00 |