| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,694 |
10,634 |
$560K |
| D0120 |
Periodic oral evaluation - established patient |
14,901 |
14,802 |
$439K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,590 |
14,512 |
$432K |
| D1110 |
Prophylaxis - adult |
4,585 |
4,547 |
$319K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
845 |
613 |
$96K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,682 |
3,357 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
662 |
659 |
$58K |
| D0272 |
Bitewings - two radiographic images |
1,542 |
1,531 |
$47K |
| D0274 |
Bitewings - four radiographic images |
677 |
672 |
$29K |
| D9110 |
|
207 |
201 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
177 |
177 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
103 |
64 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
74 |
39 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
136 |
135 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
17 |
17 |
$833.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$312.00 |