| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,269 |
1,252 |
$52K |
| D1110 |
Prophylaxis - adult |
767 |
752 |
$50K |
| D0274 |
Bitewings - four radiographic images |
752 |
745 |
$38K |
| D1330 |
|
1,004 |
992 |
$37K |
| D1206 |
Topical application of fluoride varnish |
982 |
964 |
$33K |
| D0330 |
Panoramic radiographic image |
344 |
334 |
$31K |
| D1120 |
Prophylaxis - child |
583 |
574 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
250 |
175 |
$26K |
| D1351 |
Sealant - per tooth |
238 |
76 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
111 |
91 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
198 |
186 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
138 |
135 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
25 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
23 |
18 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
92 |
88 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
115 |
112 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
31 |
30 |
$1K |