| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,366 |
4,270 |
$143K |
| D0120 |
Periodic oral evaluation - established patient |
4,837 |
4,747 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,692 |
809 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,951 |
5,826 |
$91K |
| D1351 |
Sealant - per tooth |
3,471 |
885 |
$73K |
| D1110 |
Prophylaxis - adult |
1,706 |
1,677 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
850 |
506 |
$63K |
| D0330 |
Panoramic radiographic image |
1,202 |
1,177 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,732 |
1,688 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
604 |
326 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,718 |
1,676 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,364 |
2,299 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,757 |
1,705 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
899 |
875 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
336 |
317 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
499 |
383 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
38 |
25 |
$4K |
| D0270 |
|
327 |
321 |
$3K |
| D0240 |
|
223 |
158 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$296.63 |
| D0210 |
Intraoral - complete series of radiographic images |
297 |
291 |
$69.58 |