| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,629 |
2,547 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
3,444 |
3,335 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
802 |
415 |
$53K |
| D1110 |
Prophylaxis - adult |
1,311 |
1,262 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,277 |
2,185 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
683 |
656 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,047 |
1,013 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,095 |
1,082 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
295 |
153 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,269 |
407 |
$12K |
| D0272 |
Bitewings - two radiographic images |
639 |
612 |
$11K |
| D1351 |
Sealant - per tooth |
385 |
130 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
346 |
336 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
666 |
641 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
50 |
29 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
15 |
$2K |
| D1353 |
|
42 |
14 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19 |
15 |
$409.50 |