| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,030 |
4,807 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
6,055 |
5,803 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,386 |
7,045 |
$2K |
| D1110 |
Prophylaxis - adult |
1,597 |
1,537 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
7,127 |
6,806 |
$1K |
| D0274 |
Bitewings - four radiographic images |
2,708 |
2,603 |
$1K |
| D1351 |
Sealant - per tooth |
3,737 |
1,418 |
$954.72 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
716 |
596 |
$783.48 |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,972 |
6,532 |
$687.11 |
| D0272 |
Bitewings - two radiographic images |
3,737 |
3,574 |
$634.16 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,094 |
1,034 |
$554.88 |
| D1353 |
|
3,860 |
1,280 |
$217.94 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,107 |
995 |
$150.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,383 |
969 |
$149.24 |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
14 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
24 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
60 |
51 |
$0.00 |