| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,465 |
2,465 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
2,466 |
2,466 |
$61K |
| D1351 |
Sealant - per tooth |
2,392 |
697 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,124 |
2,124 |
$52K |
| D0330 |
Panoramic radiographic image |
456 |
456 |
$20K |
| D0272 |
Bitewings - two radiographic images |
956 |
956 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
212 |
130 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
704 |
668 |
$11K |
| D1206 |
Topical application of fluoride varnish |
585 |
585 |
$10K |
| D0601 |
|
996 |
996 |
$10K |
| D1110 |
Prophylaxis - adult |
206 |
206 |
$9K |
| D0602 |
|
600 |
600 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
193 |
193 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
77 |
42 |
$4K |
| D1353 |
|
348 |
158 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
52 |
39 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
86 |
86 |
$2K |
| D0240 |
|
87 |
87 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
37 |
$955.00 |
| D0220 |
Intraoral - periapical first radiographic image |
55 |
54 |
$480.00 |
| D0603 |
|
42 |
42 |
$420.00 |