| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,011 |
5,928 |
$227K |
| D0120 |
Periodic oral evaluation - established patient |
7,043 |
6,970 |
$219K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,826 |
7,725 |
$144K |
| D1351 |
Sealant - per tooth |
3,728 |
916 |
$116K |
| D1110 |
Prophylaxis - adult |
1,859 |
1,835 |
$99K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,122 |
1,976 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
787 |
411 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
618 |
348 |
$66K |
| D0272 |
Bitewings - two radiographic images |
1,917 |
1,892 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
437 |
255 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
519 |
498 |
$29K |
| D0330 |
Panoramic radiographic image |
464 |
452 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
223 |
209 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
902 |
870 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
53 |
26 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
498 |
288 |
$2K |
| D0274 |
Bitewings - four radiographic images |
38 |
38 |
$1K |