| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
957 |
951 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
561 |
559 |
$43K |
| D1120 |
Prophylaxis - child |
823 |
817 |
$37K |
| D1110 |
Prophylaxis - adult |
402 |
399 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,183 |
1,387 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
322 |
158 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
296 |
140 |
$16K |
| D1206 |
Topical application of fluoride varnish |
1,000 |
995 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,192 |
1,178 |
$14K |
| D9430 |
|
247 |
234 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
63 |
36 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
348 |
330 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
254 |
250 |
$4K |
| D4341 |
|
42 |
12 |
$3K |
| D1351 |
Sealant - per tooth |
97 |
24 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
31 |
25 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
12 |
$1K |