| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,411 |
2,315 |
$130K |
| D0120 |
Periodic oral evaluation - established patient |
3,273 |
3,145 |
$82K |
| D0274 |
Bitewings - four radiographic images |
1,195 |
1,137 |
$44K |
| D1206 |
Topical application of fluoride varnish |
1,934 |
1,878 |
$44K |
| D1120 |
Prophylaxis - child |
1,233 |
1,204 |
$43K |
| D1351 |
Sealant - per tooth |
1,272 |
183 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
413 |
296 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
541 |
520 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
349 |
308 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
635 |
580 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
433 |
409 |
$16K |
| D0272 |
Bitewings - two radiographic images |
544 |
530 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
135 |
102 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
140 |
108 |
$11K |
| D2140 |
|
150 |
118 |
$10K |
| D0330 |
Panoramic radiographic image |
135 |
128 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
376 |
356 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$268.68 |