| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,982 |
5,977 |
$229K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,352 |
844 |
$178K |
| D1206 |
Topical application of fluoride varnish |
8,005 |
7,989 |
$171K |
| D0120 |
Periodic oral evaluation - established patient |
4,621 |
4,620 |
$120K |
| D1110 |
Prophylaxis - adult |
2,260 |
2,255 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,026 |
679 |
$106K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,993 |
2,784 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
6,372 |
6,342 |
$82K |
| D0210 |
Intraoral - complete series of radiographic images |
896 |
894 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,741 |
5,733 |
$74K |
| D0272 |
Bitewings - two radiographic images |
3,203 |
3,202 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,105 |
1,105 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,194 |
1,194 |
$36K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
250 |
136 |
$32K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
173 |
112 |
$23K |
| D1351 |
Sealant - per tooth |
615 |
206 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
103 |
69 |
$11K |
| D0350 |
|
212 |
156 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
279 |
279 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
151 |
149 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
15 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
180 |
180 |
$3K |
| D3120 |
|
50 |
40 |
$2K |
| D7111 |
|
16 |
12 |
$779.04 |