| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,981 |
6,970 |
$216K |
| D0120 |
Periodic oral evaluation - established patient |
7,637 |
7,627 |
$168K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,142 |
1,113 |
$144K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
471 |
455 |
$98K |
| D2140 |
|
973 |
960 |
$94K |
| D0272 |
Bitewings - two radiographic images |
4,289 |
4,279 |
$86K |
| D1351 |
Sealant - per tooth |
1,202 |
1,012 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,316 |
4,311 |
$76K |
| D0274 |
Bitewings - four radiographic images |
2,422 |
2,420 |
$73K |
| D0210 |
Intraoral - complete series of radiographic images |
1,368 |
1,366 |
$65K |
| D1206 |
Topical application of fluoride varnish |
3,902 |
3,892 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
3,994 |
3,966 |
$53K |
| D1110 |
Prophylaxis - adult |
1,716 |
1,713 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
627 |
575 |
$51K |
| D9630 |
|
1,300 |
1,204 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,782 |
1,719 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,268 |
3,174 |
$35K |
| D7111 |
|
420 |
420 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
956 |
954 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
275 |
266 |
$16K |
| D2160 |
|
120 |
120 |
$12K |
| D0330 |
Panoramic radiographic image |
463 |
463 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
95 |
84 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
210 |
208 |
$5K |