| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,445 |
1,432 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
1,645 |
1,573 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,650 |
2,617 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,975 |
1,932 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
3,869 |
3,727 |
$21K |
| D1110 |
Prophylaxis - adult |
875 |
866 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,650 |
2,515 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
286 |
167 |
$10K |
| D0274 |
Bitewings - four radiographic images |
703 |
691 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
128 |
74 |
$8K |
| D0272 |
Bitewings - two radiographic images |
849 |
843 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
308 |
306 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
155 |
155 |
$4K |
| D9996 |
|
212 |
194 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
24 |
$2K |
| D1999 |
|
1,001 |
837 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$102.70 |
| D1330 |
|
1,500 |
1,454 |
$36.86 |