| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,698 |
4,260 |
$174K |
| D0120 |
Periodic oral evaluation - established patient |
5,730 |
5,128 |
$134K |
| D1110 |
Prophylaxis - adult |
2,421 |
2,198 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,310 |
4,756 |
$103K |
| D1351 |
Sealant - per tooth |
3,439 |
420 |
$103K |
| D0330 |
Panoramic radiographic image |
1,242 |
1,141 |
$75K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
792 |
563 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
947 |
515 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,865 |
1,686 |
$61K |
| D0272 |
Bitewings - two radiographic images |
2,307 |
2,099 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,351 |
1,152 |
$54K |
| D2140 |
|
604 |
447 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
351 |
256 |
$37K |
| D0274 |
Bitewings - four radiographic images |
961 |
860 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
1,516 |
1,357 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
255 |
175 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
509 |
475 |
$17K |
| D1320 |
|
425 |
334 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
112 |
29 |
$1K |