| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,706 |
1,679 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
516 |
352 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
1,781 |
1,749 |
$75K |
| D1206 |
Topical application of fluoride varnish |
2,184 |
2,151 |
$71K |
| D1351 |
Sealant - per tooth |
1,170 |
352 |
$48K |
| D0274 |
Bitewings - four radiographic images |
900 |
899 |
$45K |
| D1110 |
Prophylaxis - adult |
491 |
487 |
$38K |
| D0272 |
Bitewings - two radiographic images |
895 |
895 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
238 |
172 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
485 |
485 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
227 |
119 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,118 |
1,081 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
385 |
343 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
118 |
81 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
474 |
460 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
149 |
148 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
282 |
208 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
45 |
45 |
$2K |