| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,894 |
7,553 |
$315K |
| D0120 |
Periodic oral evaluation - established patient |
7,319 |
6,973 |
$196K |
| D1351 |
Sealant - per tooth |
3,970 |
1,598 |
$195K |
| D1206 |
Topical application of fluoride varnish |
4,164 |
4,158 |
$112K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,432 |
3,103 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,192 |
3,019 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,073 |
815 |
$69K |
| D0274 |
Bitewings - four radiographic images |
3,835 |
3,602 |
$64K |
| D1110 |
Prophylaxis - adult |
1,551 |
1,434 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
583 |
534 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
5,855 |
5,578 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
660 |
519 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,317 |
1,252 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,291 |
4,014 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,852 |
1,791 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
305 |
199 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
467 |
426 |
$10K |
| D2160 |
|
113 |
54 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
106 |
65 |
$6K |
| D4341 |
|
27 |
14 |
$5K |
| D9310 |
|
93 |
93 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
14 |
$803.60 |
| D0330 |
Panoramic radiographic image |
27 |
27 |
$582.12 |
| D0270 |
|
26 |
26 |
$140.00 |