| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
8,190 |
7,640 |
$398K |
| D1120 |
Prophylaxis - child |
7,679 |
7,141 |
$388K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,415 |
4,109 |
$130K |
| D0120 |
Periodic oral evaluation - established patient |
3,963 |
3,693 |
$118K |
| D0272 |
Bitewings - two radiographic images |
3,922 |
3,622 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,243 |
743 |
$64K |
| D1110 |
Prophylaxis - adult |
1,395 |
1,328 |
$44K |
| D0330 |
Panoramic radiographic image |
992 |
874 |
$30K |
| D0274 |
Bitewings - four radiographic images |
948 |
889 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,083 |
933 |
$18K |
| D1351 |
Sealant - per tooth |
706 |
245 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
212 |
157 |
$9K |
| D8660 |
|
106 |
80 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
84 |
51 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
29 |
15 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
189 |
154 |
$2K |
| D0340 |
|
71 |
49 |
$2K |
| D0350 |
|
70 |
49 |
$881.50 |
| D0240 |
|
883 |
410 |
$651.86 |
| D1208 |
Topical application of fluoride, excluding varnish |
70 |
56 |
$553.90 |
| D1999 |
|
38 |
36 |
$0.00 |
| D1330 |
|
1,866 |
1,769 |
$0.00 |