| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
948 |
946 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,197 |
1,194 |
$46K |
| D1206 |
Topical application of fluoride varnish |
1,414 |
1,410 |
$44K |
| D1110 |
Prophylaxis - adult |
458 |
457 |
$32K |
| D0274 |
Bitewings - four radiographic images |
610 |
609 |
$31K |
| D0272 |
Bitewings - two radiographic images |
852 |
850 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
114 |
85 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
528 |
289 |
$18K |
| D1351 |
Sealant - per tooth |
449 |
160 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
245 |
245 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
454 |
450 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
55 |
38 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
61 |
28 |
$6K |
| D2140 |
|
36 |
25 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
58 |
41 |
$4K |
| D0330 |
Panoramic radiographic image |
27 |
27 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$492.00 |