| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,727 |
8,513 |
$275K |
| D1120 |
Prophylaxis - child |
6,155 |
5,931 |
$228K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,743 |
9,498 |
$180K |
| D1110 |
Prophylaxis - adult |
1,125 |
1,106 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
573 |
357 |
$60K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,454 |
1,271 |
$56K |
| D0272 |
Bitewings - two radiographic images |
859 |
851 |
$22K |
| D0274 |
Bitewings - four radiographic images |
507 |
484 |
$17K |
| D1351 |
Sealant - per tooth |
320 |
121 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
128 |
127 |
$7K |
| D0330 |
Panoramic radiographic image |
99 |
97 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
52 |
50 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
95 |
94 |
$637.00 |