| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,316 |
11,247 |
$542K |
| D1206 |
Topical application of fluoride varnish |
12,884 |
12,798 |
$311K |
| D0120 |
Periodic oral evaluation - established patient |
11,601 |
11,519 |
$308K |
| D0272 |
Bitewings - two radiographic images |
4,478 |
4,446 |
$123K |
| D1110 |
Prophylaxis - adult |
1,212 |
1,195 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,198 |
1,195 |
$67K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
470 |
291 |
$49K |
| D1351 |
Sealant - per tooth |
1,098 |
273 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,419 |
1,332 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
292 |
138 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
217 |
119 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
898 |
883 |
$16K |
| D0330 |
Panoramic radiographic image |
154 |
151 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
574 |
293 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
68 |
65 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
65 |
64 |
$2K |
| D9920 |
|
16 |
16 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
13 |
12 |
$460.00 |
| D1999 |
|
2,343 |
2,265 |
$0.00 |