| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
24,290 |
23,645 |
$777K |
| D0120 |
Periodic oral evaluation - established patient |
30,860 |
29,908 |
$669K |
| D1206 |
Topical application of fluoride varnish |
23,960 |
23,140 |
$607K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,119 |
2,331 |
$421K |
| D1110 |
Prophylaxis - adult |
8,811 |
8,521 |
$377K |
| D0272 |
Bitewings - two radiographic images |
9,430 |
9,193 |
$189K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,965 |
1,436 |
$167K |
| D0330 |
Panoramic radiographic image |
2,501 |
2,466 |
$151K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,759 |
5,368 |
$149K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,014 |
1,157 |
$138K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,267 |
8,094 |
$132K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,670 |
2,620 |
$101K |
| D0274 |
Bitewings - four radiographic images |
2,400 |
2,371 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
1,367 |
1,325 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
1,631 |
1,607 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
982 |
964 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
40 |
40 |
$1K |
| D1999 |
|
53 |
53 |
$0.00 |
| D9920 |
|
51 |
50 |
$0.00 |