| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,618 |
1,613 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
1,680 |
1,677 |
$47K |
| D1206 |
Topical application of fluoride varnish |
1,840 |
1,836 |
$46K |
| D1351 |
Sealant - per tooth |
464 |
119 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
184 |
109 |
$17K |
| D1110 |
Prophylaxis - adult |
247 |
247 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
238 |
237 |
$13K |
| D0272 |
Bitewings - two radiographic images |
455 |
455 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
77 |
47 |
$7K |
| D0274 |
Bitewings - four radiographic images |
167 |
167 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
332 |
326 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
296 |
275 |
$6K |
| D0330 |
Panoramic radiographic image |
60 |
59 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
282 |
194 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
27 |
$3K |