| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,566 |
6,252 |
$160K |
| D1110 |
Prophylaxis - adult |
4,042 |
3,832 |
$147K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
954 |
629 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,576 |
7,212 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
793 |
527 |
$58K |
| D1120 |
Prophylaxis - child |
1,952 |
1,861 |
$51K |
| D0330 |
Panoramic radiographic image |
898 |
834 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,098 |
1,031 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
669 |
613 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,416 |
1,340 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,627 |
1,497 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
412 |
379 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
213 |
66 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
764 |
476 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
66 |
37 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
25 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
116 |
109 |
$4K |
| D9239 |
|
38 |
36 |
$3K |
| D2140 |
|
40 |
29 |
$2K |