| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,352 |
2,927 |
$212K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,285 |
1,136 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,317 |
1,950 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
374 |
319 |
$29K |
| D1110 |
Prophylaxis - adult |
603 |
590 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
350 |
245 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
318 |
272 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
623 |
591 |
$15K |
| D0274 |
Bitewings - four radiographic images |
1,095 |
1,045 |
$14K |
| D1351 |
Sealant - per tooth |
118 |
83 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
312 |
301 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,513 |
1,419 |
$8K |
| D1206 |
Topical application of fluoride varnish |
1,436 |
1,097 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
325 |
316 |
$8K |
| D4341 |
|
43 |
24 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,272 |
1,176 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
65 |
55 |
$3K |
| D0272 |
Bitewings - two radiographic images |
333 |
314 |
$2K |
| D2331 |
|
13 |
12 |
$934.20 |
| D2332 |
|
15 |
12 |
$773.80 |
| D2140 |
|
18 |
17 |
$647.85 |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$470.10 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
13 |
$0.00 |
| D1999 |
|
194 |
157 |
$0.00 |