| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,011 |
3,898 |
$102K |
| D1206 |
Topical application of fluoride varnish |
3,557 |
3,454 |
$57K |
| D1110 |
Prophylaxis - adult |
1,536 |
1,492 |
$56K |
| D1120 |
Prophylaxis - child |
2,052 |
2,002 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
428 |
314 |
$34K |
| D0272 |
Bitewings - two radiographic images |
601 |
584 |
$11K |
| D0274 |
Bitewings - four radiographic images |
267 |
256 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
224 |
220 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
65 |
56 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
335 |
318 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
107 |
106 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
72 |
67 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
54 |
25 |
$1K |
| D2140 |
|
18 |
12 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
12 |
$981.60 |
| D0330 |
Panoramic radiographic image |
14 |
12 |
$715.55 |
| D0240 |
|
20 |
12 |
$303.80 |