| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,103 |
2,998 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
3,290 |
3,188 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,764 |
2,680 |
$71K |
| D1351 |
Sealant - per tooth |
750 |
508 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
980 |
803 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,493 |
1,347 |
$34K |
| D4341 |
|
172 |
101 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,754 |
1,662 |
$29K |
| D1110 |
Prophylaxis - adult |
619 |
610 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
3,513 |
3,270 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
437 |
371 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
221 |
176 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,918 |
2,698 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
160 |
95 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
282 |
231 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
678 |
655 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
122 |
102 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
600 |
479 |
$6K |
| D0272 |
Bitewings - two radiographic images |
469 |
456 |
$5K |
| D1206 |
Topical application of fluoride varnish |
155 |
142 |
$4K |
| D0330 |
Panoramic radiographic image |
145 |
135 |
$2K |
| D2950 |
|
19 |
15 |
$1K |