| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
603 |
572 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
786 |
733 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
252 |
171 |
$19K |
| D1110 |
Prophylaxis - adult |
388 |
344 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
562 |
533 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
593 |
552 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
228 |
133 |
$11K |
| D1351 |
Sealant - per tooth |
238 |
95 |
$11K |
| D0274 |
Bitewings - four radiographic images |
755 |
697 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
176 |
115 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,472 |
1,360 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,582 |
1,237 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
191 |
176 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
51 |
33 |
$3K |
| D0330 |
Panoramic radiographic image |
131 |
117 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
157 |
150 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
31 |
$2K |
| D2140 |
|
38 |
27 |
$1K |
| D0270 |
|
244 |
233 |
$1K |
| D0272 |
Bitewings - two radiographic images |
117 |
111 |
$996.40 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$338.00 |