| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,864 |
3,763 |
$108.00 |
| D0120 |
Periodic oral evaluation - established patient |
4,181 |
4,080 |
$75.00 |
| D1206 |
Topical application of fluoride varnish |
2,207 |
2,180 |
$34.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,172 |
2,094 |
$30.00 |
| D0220 |
Intraoral - periapical first radiographic image |
3,093 |
3,002 |
$30.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
2,285 |
2,185 |
$17.00 |
| D0272 |
Bitewings - two radiographic images |
2,028 |
1,970 |
$17.00 |
| D1351 |
Sealant - per tooth |
1,085 |
391 |
$0.00 |
| D0603 |
|
1,205 |
1,155 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
360 |
337 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
229 |
115 |
$0.00 |
| D0602 |
|
13 |
12 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
12 |
$0.00 |
| D0330 |
Panoramic radiographic image |
415 |
395 |
$0.00 |
| D1999 |
|
3,625 |
3,349 |
$0.00 |
| D1110 |
Prophylaxis - adult |
598 |
579 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
396 |
389 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
187 |
164 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
429 |
265 |
$0.00 |