| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,264 |
7,976 |
$335K |
| D0120 |
Periodic oral evaluation - established patient |
9,751 |
9,400 |
$268K |
| D1351 |
Sealant - per tooth |
3,983 |
1,917 |
$235K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,931 |
7,651 |
$204K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,843 |
1,955 |
$178K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,943 |
1,338 |
$139K |
| D1110 |
Prophylaxis - adult |
1,947 |
1,897 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,280 |
993 |
$65K |
| D0274 |
Bitewings - four radiographic images |
3,715 |
3,537 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,384 |
1,278 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,280 |
2,213 |
$52K |
| D4341 |
|
288 |
171 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
8,428 |
8,023 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,481 |
7,070 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
1,062 |
1,024 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,721 |
1,665 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,715 |
2,619 |
$25K |
| D9110 |
|
330 |
324 |
$18K |