| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,802 |
2,801 |
$93K |
| D1206 |
Topical application of fluoride varnish |
3,301 |
3,300 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
3,145 |
3,144 |
$63K |
| D1110 |
Prophylaxis - adult |
866 |
866 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,282 |
1,281 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
716 |
699 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
272 |
228 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
301 |
215 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
615 |
615 |
$19K |
| D2140 |
|
249 |
194 |
$15K |
| D9248 |
|
118 |
116 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
551 |
545 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
280 |
280 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
77 |
62 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
162 |
162 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
143 |
136 |
$2K |
| D0330 |
Panoramic radiographic image |
22 |
22 |
$1K |