| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,740 |
6,456 |
$149K |
| D1206 |
Topical application of fluoride varnish |
6,830 |
5,726 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
4,578 |
4,098 |
$107K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,169 |
567 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,543 |
2,090 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
1,758 |
1,514 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
998 |
835 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,057 |
2,309 |
$34K |
| D1351 |
Sealant - per tooth |
1,055 |
142 |
$29K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
516 |
276 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,768 |
1,390 |
$23K |
| D2140 |
|
467 |
273 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
831 |
728 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
266 |
233 |
$4K |
| D0330 |
Panoramic radiographic image |
57 |
56 |
$3K |
| D1110 |
Prophylaxis - adult |
77 |
63 |
$2K |