| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,962 |
10,410 |
$543K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,399 |
11,799 |
$351K |
| D0120 |
Periodic oral evaluation - established patient |
10,113 |
9,610 |
$286K |
| D0274 |
Bitewings - four radiographic images |
4,219 |
3,973 |
$177K |
| D9450 |
|
7,401 |
6,330 |
$162K |
| D1110 |
Prophylaxis - adult |
1,771 |
1,683 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,258 |
1,166 |
$70K |
| D7140 |
Extraction, erupted tooth or exposed root |
376 |
131 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,215 |
1,124 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
182 |
89 |
$20K |
| D0272 |
Bitewings - two radiographic images |
673 |
665 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
922 |
800 |
$18K |
| D0330 |
Panoramic radiographic image |
204 |
196 |
$17K |
| D1351 |
Sealant - per tooth |
393 |
126 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
254 |
232 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
86 |
61 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
83 |
40 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
39 |
12 |
$422.00 |
| D1999 |
|
1,643 |
1,523 |
$0.00 |