| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,414 |
3,250 |
$142K |
| D1351 |
Sealant - per tooth |
1,554 |
1,025 |
$130K |
| D0120 |
Periodic oral evaluation - established patient |
3,185 |
3,050 |
$91K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,272 |
3,114 |
$87K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,532 |
1,228 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
595 |
491 |
$45K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
344 |
246 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
197 |
178 |
$18K |
| D9110 |
|
337 |
334 |
$18K |
| D2160 |
|
183 |
142 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
479 |
458 |
$11K |
| D0274 |
Bitewings - four radiographic images |
216 |
216 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
84 |
58 |
$4K |
| D1206 |
Topical application of fluoride varnish |
105 |
102 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
318 |
317 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
295 |
295 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
68 |
67 |
$1K |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$580.56 |
| D0272 |
Bitewings - two radiographic images |
43 |
43 |
$476.87 |