| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,329 |
11,105 |
$559K |
| D1206 |
Topical application of fluoride varnish |
14,088 |
13,754 |
$352K |
| D0120 |
Periodic oral evaluation - established patient |
12,190 |
11,915 |
$339K |
| D1110 |
Prophylaxis - adult |
2,656 |
2,550 |
$169K |
| D1351 |
Sealant - per tooth |
3,477 |
882 |
$132K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,157 |
713 |
$109K |
| D0272 |
Bitewings - two radiographic images |
3,458 |
3,355 |
$100K |
| D0330 |
Panoramic radiographic image |
1,006 |
993 |
$86K |
| D0274 |
Bitewings - four radiographic images |
2,109 |
1,988 |
$83K |
| D9450 |
|
4,099 |
3,549 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
693 |
404 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
1,546 |
1,479 |
$29K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
242 |
151 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
349 |
349 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
916 |
757 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
327 |
296 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
89 |
68 |
$8K |
| D9110 |
|
95 |
93 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
25 |
$4K |
| D3120 |
|
117 |
97 |
$2K |