| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,504 |
5,243 |
$233K |
| D0120 |
Periodic oral evaluation - established patient |
8,441 |
8,065 |
$165K |
| D1120 |
Prophylaxis - child |
4,251 |
4,076 |
$120K |
| D0272 |
Bitewings - two radiographic images |
4,761 |
4,522 |
$99K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,683 |
2,569 |
$93K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,386 |
925 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,228 |
4,021 |
$68K |
| D1206 |
Topical application of fluoride varnish |
2,828 |
2,738 |
$61K |
| D1351 |
Sealant - per tooth |
2,308 |
716 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,025 |
966 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
449 |
420 |
$16K |
| D0330 |
Panoramic radiographic image |
349 |
327 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
750 |
689 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
100 |
74 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
121 |
92 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
126 |
98 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
94 |
65 |
$5K |
| D2140 |
|
150 |
126 |
$4K |
| D2332 |
|
21 |
15 |
$2K |
| D0274 |
Bitewings - four radiographic images |
43 |
42 |
$1K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
15 |
12 |
$0.00 |
| D0707 |
|
12 |
12 |
$0.00 |
| D3120 |
|
185 |
124 |
$0.00 |