| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,594 |
1,386 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
554 |
304 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
721 |
343 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,924 |
1,678 |
$30K |
| D1351 |
Sealant - per tooth |
1,648 |
248 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,026 |
1,751 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,706 |
704 |
$20K |
| D1110 |
Prophylaxis - adult |
509 |
432 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
639 |
426 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
818 |
687 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
351 |
271 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
309 |
268 |
$7K |
| D0274 |
Bitewings - four radiographic images |
313 |
268 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
114 |
67 |
$5K |
| D0330 |
Panoramic radiographic image |
17 |
13 |
$368.40 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$246.81 |