| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,334 |
1,332 |
$55K |
| D1206 |
Topical application of fluoride varnish |
1,921 |
1,916 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,823 |
1,818 |
$50K |
| D1110 |
Prophylaxis - adult |
630 |
627 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
454 |
442 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
307 |
228 |
$22K |
| D0272 |
Bitewings - two radiographic images |
631 |
628 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
264 |
230 |
$17K |
| D0274 |
Bitewings - four radiographic images |
447 |
447 |
$16K |
| D1330 |
|
1,579 |
1,576 |
$14K |
| D0330 |
Panoramic radiographic image |
100 |
100 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
86 |
86 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
272 |
269 |
$3K |
| D1351 |
Sealant - per tooth |
70 |
24 |
$3K |
| D0603 |
|
230 |
228 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
13 |
$2K |
| D0270 |
|
104 |
104 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
41 |
39 |
$449.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
38 |
38 |
$370.00 |
| D0602 |
|
26 |
26 |
$260.00 |