| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,763 |
3,938 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
3,701 |
3,131 |
$95K |
| D1206 |
Topical application of fluoride varnish |
3,558 |
2,829 |
$67K |
| D0272 |
Bitewings - two radiographic images |
2,237 |
1,970 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
694 |
608 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,306 |
1,223 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
380 |
338 |
$15K |
| D0330 |
Panoramic radiographic image |
255 |
230 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
978 |
858 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
428 |
364 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
98 |
56 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
126 |
49 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
15 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
138 |
63 |
$1K |
| D1999 |
|
12 |
12 |
$0.00 |