| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,041 |
8,928 |
$446K |
| D1206 |
Topical application of fluoride varnish |
10,757 |
10,626 |
$273K |
| D0120 |
Periodic oral evaluation - established patient |
8,553 |
8,446 |
$241K |
| D0272 |
Bitewings - two radiographic images |
2,541 |
2,513 |
$72K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
642 |
402 |
$71K |
| D8670 |
Periodic orthodontic treatment visit |
180 |
168 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,026 |
987 |
$42K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
397 |
217 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,344 |
1,218 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
886 |
854 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
276 |
275 |
$14K |
| D1351 |
Sealant - per tooth |
332 |
102 |
$13K |
| D1110 |
Prophylaxis - adult |
183 |
178 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
26 |
$4K |
| D0274 |
Bitewings - four radiographic images |
60 |
60 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
151 |
67 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$1K |
| D8660 |
|
15 |
15 |
$434.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
12 |
$324.00 |
| D0240 |
|
23 |
12 |
$308.00 |