| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,542 |
10,232 |
$316K |
| D0120 |
Periodic oral evaluation - established patient |
13,718 |
13,306 |
$277K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,964 |
12,550 |
$195K |
| D0272 |
Bitewings - two radiographic images |
7,019 |
6,808 |
$130K |
| D1110 |
Prophylaxis - adult |
3,083 |
2,994 |
$121K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,462 |
3,186 |
$79K |
| D0274 |
Bitewings - four radiographic images |
1,886 |
1,842 |
$48K |
| D1206 |
Topical application of fluoride varnish |
1,646 |
1,619 |
$46K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
757 |
421 |
$42K |
| D0330 |
Panoramic radiographic image |
595 |
574 |
$30K |
| D1351 |
Sealant - per tooth |
1,252 |
266 |
$30K |
| D1999 |
|
1,095 |
1,033 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,148 |
1,081 |
$12K |
| D2140 |
|
273 |
161 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
385 |
342 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
145 |
72 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
63 |
38 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
521 |
494 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
29 |
26 |
$875.00 |