| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,080 |
3,076 |
$136K |
| D1206 |
Topical application of fluoride varnish |
3,066 |
3,062 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
3,161 |
3,158 |
$79K |
| D9920 |
|
1,979 |
1,959 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
439 |
250 |
$31K |
| D0272 |
Bitewings - two radiographic images |
2,298 |
2,295 |
$23K |
| D1110 |
Prophylaxis - adult |
409 |
408 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
374 |
371 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
241 |
154 |
$13K |
| D1351 |
Sealant - per tooth |
648 |
120 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
523 |
483 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,664 |
1,645 |
$8K |
| D0603 |
|
619 |
617 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
122 |
84 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,269 |
1,268 |
$4K |
| D0274 |
Bitewings - four radiographic images |
321 |
321 |
$4K |
| D0330 |
Panoramic radiographic image |
78 |
78 |
$3K |
| D0601 |
|
288 |
288 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
114 |
114 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
64 |
64 |
$2K |
| D0602 |
|
30 |
30 |
$290.00 |
| D0240 |
|
12 |
12 |
$240.00 |