| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,477 |
5,445 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
7,392 |
7,352 |
$131K |
| D0274 |
Bitewings - four radiographic images |
3,653 |
3,635 |
$94K |
| D0220 |
Intraoral - periapical first radiographic image |
7,800 |
7,752 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,443 |
5,417 |
$76K |
| D1110 |
Prophylaxis - adult |
2,776 |
2,757 |
$70K |
| D0272 |
Bitewings - two radiographic images |
3,797 |
3,773 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,654 |
7,581 |
$64K |
| D1351 |
Sealant - per tooth |
1,700 |
756 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
924 |
647 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
359 |
358 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
468 |
465 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
123 |
82 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
305 |
302 |
$6K |
| D2140 |
|
22 |
12 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
13 |
$901.35 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
13 |
$842.71 |