| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
862 |
846 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,308 |
1,243 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,260 |
1,244 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
261 |
176 |
$17K |
| D0274 |
Bitewings - four radiographic images |
980 |
935 |
$16K |
| D1351 |
Sealant - per tooth |
359 |
128 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,335 |
2,227 |
$15K |
| D1110 |
Prophylaxis - adult |
386 |
358 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,413 |
1,960 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
252 |
165 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
99 |
97 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
444 |
424 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
138 |
84 |
$6K |
| D2140 |
|
137 |
99 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
181 |
174 |
$3K |
| D0272 |
Bitewings - two radiographic images |
157 |
154 |
$1K |
| D0270 |
|
265 |
260 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
20 |
$1K |
| D2160 |
|
22 |
17 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
34 |
32 |
$1K |
| D0330 |
Panoramic radiographic image |
57 |
53 |
$551.36 |
| D0603 |
|
1,566 |
1,522 |
$0.01 |