| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,916 |
7,901 |
$227K |
| D1120 |
Prophylaxis - child |
5,636 |
5,610 |
$202K |
| D1110 |
Prophylaxis - adult |
3,763 |
3,742 |
$192K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,796 |
5,789 |
$120K |
| D0272 |
Bitewings - two radiographic images |
4,451 |
4,432 |
$100K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
895 |
626 |
$67K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,674 |
1,576 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
553 |
410 |
$58K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
523 |
336 |
$44K |
| D1206 |
Topical application of fluoride varnish |
1,638 |
1,636 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
535 |
529 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
203 |
203 |
$9K |
| D1351 |
Sealant - per tooth |
264 |
77 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
321 |
316 |
$5K |
| D2140 |
|
46 |
30 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$195.00 |