| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,133 |
4,130 |
$163K |
| D0120 |
Periodic oral evaluation - established patient |
3,782 |
3,779 |
$103K |
| D1206 |
Topical application of fluoride varnish |
4,129 |
4,126 |
$77K |
| D0272 |
Bitewings - two radiographic images |
1,636 |
1,630 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
300 |
138 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
506 |
506 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
292 |
262 |
$7K |
| D1110 |
Prophylaxis - adult |
103 |
103 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
64 |
37 |
$4K |
| D0330 |
Panoramic radiographic image |
83 |
83 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
32 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
80 |
79 |
$3K |
| D0240 |
|
156 |
86 |
$2K |
| D0603 |
|
211 |
210 |
$2K |
| D1330 |
|
101 |
101 |
$820.00 |
| D0601 |
|
40 |
40 |
$429.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$348.00 |
| D1354 |
|
77 |
13 |
$168.00 |