| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,909 |
3,862 |
$215K |
| D1110 |
Prophylaxis - adult |
940 |
927 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
4,474 |
4,420 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,142 |
702 |
$61K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
302 |
230 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
271 |
266 |
$19K |
| D0330 |
Panoramic radiographic image |
261 |
258 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
142 |
90 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
299 |
293 |
$5K |
| D1351 |
Sealant - per tooth |
902 |
274 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
3,944 |
3,877 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
732 |
705 |
$2K |
| D1330 |
|
4,830 |
4,771 |
$340.83 |
| D0272 |
Bitewings - two radiographic images |
2,964 |
2,929 |
$225.63 |
| D0274 |
Bitewings - four radiographic images |
971 |
955 |
$177.82 |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,648 |
3,588 |
$116.16 |
| D1208 |
Topical application of fluoride, excluding varnish |
4,678 |
4,621 |
$42.86 |