| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,389 |
2,357 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
2,043 |
2,017 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,965 |
2,929 |
$53K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
764 |
409 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
2,743 |
2,695 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,449 |
1,194 |
$34K |
| D0272 |
Bitewings - two radiographic images |
2,438 |
2,409 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
620 |
327 |
$32K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
289 |
149 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,404 |
2,627 |
$26K |
| D1110 |
Prophylaxis - adult |
542 |
535 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
124 |
73 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
238 |
227 |
$9K |
| D9420 |
|
30 |
28 |
$3K |
| D1351 |
Sealant - per tooth |
86 |
43 |
$2K |
| D1999 |
|
190 |
171 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$893.85 |