| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,179 |
10,818 |
$545K |
| D1206 |
Topical application of fluoride varnish |
16,162 |
15,590 |
$400K |
| D0120 |
Periodic oral evaluation - established patient |
14,631 |
14,064 |
$399K |
| D1110 |
Prophylaxis - adult |
3,593 |
3,390 |
$221K |
| D0272 |
Bitewings - two radiographic images |
6,430 |
6,264 |
$183K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
588 |
402 |
$60K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
562 |
492 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
553 |
532 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
173 |
172 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
96 |
66 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
88 |
70 |
$7K |
| D1351 |
Sealant - per tooth |
178 |
63 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
72 |
38 |
$6K |
| D0274 |
Bitewings - four radiographic images |
131 |
122 |
$5K |
| D0330 |
Panoramic radiographic image |
65 |
63 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
60 |
39 |
$794.00 |
| D0140 |
Limited oral evaluation - problem focused |
18 |
18 |
$784.00 |
| D3120 |
|
19 |
14 |
$680.00 |