| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,812 |
3,681 |
$150K |
| D0120 |
Periodic oral evaluation - established patient |
4,287 |
4,138 |
$113K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,760 |
3,631 |
$93K |
| D1351 |
Sealant - per tooth |
1,408 |
724 |
$67K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
652 |
435 |
$39K |
| D1110 |
Prophylaxis - adult |
1,007 |
947 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,746 |
1,646 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
484 |
311 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,157 |
1,076 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
215 |
146 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
423 |
399 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,018 |
983 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,666 |
1,559 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,256 |
1,028 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
93 |
74 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
154 |
147 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
103 |
97 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
27 |
24 |
$1K |
| D0270 |
|
29 |
27 |
$134.40 |
| D1999 |
|
142 |
135 |
$0.00 |