| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,309 |
2,149 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,727 |
1,609 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
962 |
854 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,480 |
2,312 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
253 |
138 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
426 |
399 |
$19K |
| D0240 |
|
1,118 |
534 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
988 |
878 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,145 |
271 |
$9K |
| D0272 |
Bitewings - two radiographic images |
402 |
378 |
$7K |
| D1351 |
Sealant - per tooth |
230 |
45 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
24 |
$2K |
| D1110 |
Prophylaxis - adult |
43 |
42 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
36 |
$1K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$867.30 |
| D1310 |
|
21 |
21 |
$0.00 |
| D1330 |
|
21 |
21 |
$0.00 |