| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,230 |
1,212 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
1,557 |
1,534 |
$71K |
| D1206 |
Topical application of fluoride varnish |
1,859 |
1,832 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
283 |
196 |
$53K |
| D1110 |
Prophylaxis - adult |
632 |
624 |
$50K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
263 |
179 |
$47K |
| D0274 |
Bitewings - four radiographic images |
808 |
790 |
$46K |
| D0272 |
Bitewings - two radiographic images |
1,065 |
1,049 |
$45K |
| D0330 |
Panoramic radiographic image |
278 |
277 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
169 |
104 |
$28K |
| D1351 |
Sealant - per tooth |
576 |
192 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
318 |
310 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
490 |
325 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
677 |
662 |
$18K |
| D2140 |
|
66 |
51 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
29 |
28 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
15 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
16 |
16 |
$775.00 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
12 |
$483.00 |