| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,586 |
2,465 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
2,771 |
2,652 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,944 |
1,838 |
$49K |
| D1351 |
Sealant - per tooth |
193 |
142 |
$14K |
| D0274 |
Bitewings - four radiographic images |
759 |
723 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,058 |
1,956 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
196 |
183 |
$11K |
| D1110 |
Prophylaxis - adult |
462 |
429 |
$11K |
| D1206 |
Topical application of fluoride varnish |
342 |
337 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,733 |
1,650 |
$7K |
| D0272 |
Bitewings - two radiographic images |
507 |
477 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
223 |
218 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
281 |
253 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
74 |
70 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
24 |
$2K |
| D9110 |
|
28 |
28 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
53 |
52 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$338.00 |