| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,732 |
7,380 |
$352K |
| D0120 |
Periodic oral evaluation - established patient |
7,308 |
6,997 |
$194K |
| D1206 |
Topical application of fluoride varnish |
6,656 |
6,339 |
$158K |
| D0272 |
Bitewings - two radiographic images |
2,809 |
2,671 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,584 |
1,530 |
$42K |
| D1351 |
Sealant - per tooth |
1,052 |
290 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,584 |
1,362 |
$29K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
366 |
193 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
452 |
418 |
$22K |
| D1110 |
Prophylaxis - adult |
336 |
318 |
$19K |
| D0330 |
Panoramic radiographic image |
242 |
223 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
242 |
210 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
122 |
84 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
385 |
359 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
26 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
37 |
26 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
58 |
54 |
$1K |
| D0274 |
Bitewings - four radiographic images |
13 |
12 |
$344.00 |
| D1330 |
|
14 |
14 |
$0.00 |