| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,980 |
2,782 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
3,495 |
3,312 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
824 |
528 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,781 |
3,543 |
$76K |
| D1110 |
Prophylaxis - adult |
1,005 |
938 |
$51K |
| D1351 |
Sealant - per tooth |
1,474 |
498 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,225 |
1,007 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
427 |
319 |
$34K |
| D0274 |
Bitewings - four radiographic images |
860 |
800 |
$27K |
| D8670 |
Periodic orthodontic treatment visit |
205 |
135 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,012 |
941 |
$25K |
| D0330 |
Panoramic radiographic image |
407 |
390 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
213 |
205 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
136 |
83 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
72 |
40 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
598 |
562 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
698 |
285 |
$6K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
28 |
28 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$728.00 |