| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,409 |
4,290 |
$293K |
| D0120 |
Periodic oral evaluation - established patient |
4,145 |
4,097 |
$205K |
| D0330 |
Panoramic radiographic image |
637 |
617 |
$55K |
| D0272 |
Bitewings - two radiographic images |
3,585 |
3,524 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
1,427 |
1,340 |
$48K |
| D0274 |
Bitewings - four radiographic images |
658 |
649 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
524 |
504 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,217 |
557 |
$42K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,365 |
541 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
4,575 |
4,481 |
$28K |
| D1206 |
Topical application of fluoride varnish |
3,904 |
3,844 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,023 |
3,940 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
303 |
133 |
$23K |
| D1351 |
Sealant - per tooth |
929 |
295 |
$18K |
| D9420 |
|
58 |
57 |
$13K |
| D2140 |
|
332 |
150 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
94 |
44 |
$6K |
| D1110 |
Prophylaxis - adult |
69 |
67 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
18 |
15 |
$2K |
| D2160 |
|
25 |
13 |
$322.89 |