| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,911 |
6,640 |
$315K |
| D0120 |
Periodic oral evaluation - established patient |
7,737 |
7,454 |
$200K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,309 |
4,107 |
$107K |
| D1206 |
Topical application of fluoride varnish |
3,878 |
3,763 |
$94K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
971 |
669 |
$83K |
| D1110 |
Prophylaxis - adult |
1,408 |
1,349 |
$82K |
| D0272 |
Bitewings - two radiographic images |
2,035 |
1,969 |
$55K |
| D1351 |
Sealant - per tooth |
1,370 |
369 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
853 |
826 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
588 |
394 |
$44K |
| D0330 |
Panoramic radiographic image |
544 |
510 |
$38K |
| D0274 |
Bitewings - four radiographic images |
956 |
923 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
365 |
169 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,383 |
1,297 |
$24K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
79 |
44 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,031 |
483 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
306 |
293 |
$13K |
| D9110 |
|
103 |
97 |
$7K |
| D2140 |
|
91 |
67 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
166 |
159 |
$3K |
| D1999 |
|
131 |
118 |
$0.00 |
| D1330 |
|
335 |
328 |
$0.00 |