| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,129 |
3,930 |
$177K |
| D1206 |
Topical application of fluoride varnish |
6,563 |
6,274 |
$163K |
| D0120 |
Periodic oral evaluation - established patient |
4,273 |
4,090 |
$126K |
| D1110 |
Prophylaxis - adult |
1,960 |
1,870 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,746 |
1,652 |
$93K |
| D1351 |
Sealant - per tooth |
2,634 |
519 |
$87K |
| D0330 |
Panoramic radiographic image |
1,573 |
1,534 |
$69K |
| D0274 |
Bitewings - four radiographic images |
1,519 |
1,436 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
746 |
732 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
280 |
196 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
222 |
166 |
$27K |
| D1330 |
|
4,307 |
4,103 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,025 |
965 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
621 |
618 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
106 |
67 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
876 |
862 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
177 |
153 |
$3K |
| D9910 |
|
233 |
185 |
$2K |