| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,985 |
10,699 |
$454K |
| D1351 |
Sealant - per tooth |
3,792 |
2,630 |
$370K |
| D0120 |
Periodic oral evaluation - established patient |
9,644 |
9,369 |
$271K |
| D1206 |
Topical application of fluoride varnish |
10,040 |
9,827 |
$265K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,529 |
1,169 |
$147K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,672 |
1,571 |
$88K |
| D7140 |
Extraction, erupted tooth or exposed root |
769 |
604 |
$52K |
| D0274 |
Bitewings - four radiographic images |
2,674 |
2,593 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
6,637 |
6,375 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,686 |
1,620 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,598 |
5,382 |
$29K |
| D0272 |
Bitewings - two radiographic images |
2,797 |
2,710 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
769 |
699 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
639 |
629 |
$12K |
| D1110 |
Prophylaxis - adult |
136 |
123 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
28 |
$3K |
| D9310 |
|
128 |
126 |
$2K |
| D2140 |
|
15 |
15 |
$709.55 |
| D1999 |
|
720 |
592 |
$0.00 |