| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,954 |
4,912 |
$246K |
| D0120 |
Periodic oral evaluation - established patient |
5,974 |
5,917 |
$193K |
| D1206 |
Topical application of fluoride varnish |
5,710 |
5,665 |
$153K |
| D0274 |
Bitewings - four radiographic images |
3,962 |
3,940 |
$136K |
| D0330 |
Panoramic radiographic image |
1,839 |
1,829 |
$104K |
| D1120 |
Prophylaxis - child |
2,460 |
2,446 |
$84K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
859 |
563 |
$67K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
753 |
493 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,042 |
2,032 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
1,788 |
1,714 |
$57K |
| D1351 |
Sealant - per tooth |
1,425 |
379 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,220 |
1,214 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
1,445 |
1,412 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
223 |
125 |
$16K |
| D2140 |
|
120 |
80 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
70 |
55 |
$5K |
| D2160 |
|
29 |
24 |
$3K |
| D2331 |
|
13 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$702.12 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$200.40 |
| D1999 |
|
444 |
381 |
$27.43 |