| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,045 |
1,997 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
2,285 |
2,234 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
750 |
578 |
$58K |
| D1351 |
Sealant - per tooth |
543 |
333 |
$49K |
| D1206 |
Topical application of fluoride varnish |
1,219 |
1,177 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
442 |
366 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
692 |
692 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
185 |
158 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
731 |
711 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,127 |
2,072 |
$13K |
| D0274 |
Bitewings - four radiographic images |
634 |
618 |
$12K |
| D1110 |
Prophylaxis - adult |
264 |
262 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,873 |
1,832 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
100 |
83 |
$7K |
| D4341 |
|
44 |
25 |
$7K |
| D0272 |
Bitewings - two radiographic images |
684 |
669 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
263 |
255 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
113 |
104 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
106 |
89 |
$3K |
| D0270 |
|
352 |
352 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
25 |
$2K |