| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,251 |
3,210 |
$161K |
| D0120 |
Periodic oral evaluation - established patient |
3,815 |
3,772 |
$108K |
| D1206 |
Topical application of fluoride varnish |
3,974 |
3,928 |
$101K |
| D1110 |
Prophylaxis - adult |
798 |
793 |
$53K |
| D0272 |
Bitewings - two radiographic images |
1,205 |
1,189 |
$35K |
| D0274 |
Bitewings - four radiographic images |
573 |
562 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,126 |
1,089 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
862 |
764 |
$17K |
| D0330 |
Panoramic radiographic image |
212 |
208 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
161 |
90 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
908 |
852 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
157 |
155 |
$9K |
| D1351 |
Sealant - per tooth |
231 |
55 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
60 |
31 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
48 |
27 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
97 |
92 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
12 |
$2K |