| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,004 |
4,488 |
$176K |
| D0140 |
Limited oral evaluation - problem focused |
4,124 |
3,581 |
$159K |
| D0120 |
Periodic oral evaluation - established patient |
5,070 |
4,708 |
$127K |
| D1206 |
Topical application of fluoride varnish |
6,184 |
5,559 |
$117K |
| D1110 |
Prophylaxis - adult |
1,944 |
1,799 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,387 |
1,214 |
$51K |
| D0330 |
Panoramic radiographic image |
839 |
742 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
369 |
173 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,256 |
1,129 |
$37K |
| D9420 |
|
176 |
167 |
$23K |
| D0272 |
Bitewings - two radiographic images |
913 |
802 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
160 |
61 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
625 |
545 |
$10K |
| D1330 |
|
870 |
802 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
25 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
59 |
50 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
29 |
26 |
$1K |
| D1351 |
Sealant - per tooth |
49 |
12 |
$1K |
| D9110 |
|
12 |
12 |
$660.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
53 |
12 |
$336.00 |