| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,084 |
9,540 |
$462K |
| D0120 |
Periodic oral evaluation - established patient |
11,882 |
11,218 |
$308K |
| D1206 |
Topical application of fluoride varnish |
11,996 |
11,337 |
$283K |
| D1110 |
Prophylaxis - adult |
1,704 |
1,587 |
$99K |
| D0272 |
Bitewings - two radiographic images |
2,557 |
2,433 |
$70K |
| D1351 |
Sealant - per tooth |
1,329 |
329 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,036 |
959 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,766 |
1,568 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
296 |
161 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
255 |
162 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
243 |
172 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
967 |
904 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
257 |
247 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
112 |
68 |
$11K |
| D0330 |
Panoramic radiographic image |
97 |
94 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
511 |
323 |
$7K |
| D1999 |
|
106 |
92 |
$0.00 |