| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,933 |
1,873 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
1,778 |
1,745 |
$49K |
| D1351 |
Sealant - per tooth |
802 |
358 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,716 |
1,658 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,599 |
1,539 |
$36K |
| D4341 |
|
148 |
73 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,757 |
1,725 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
3,196 |
3,069 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
236 |
153 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,937 |
2,747 |
$13K |
| D1110 |
Prophylaxis - adult |
193 |
190 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
212 |
209 |
$6K |
| D1206 |
Topical application of fluoride varnish |
213 |
212 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
107 |
76 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
287 |
270 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
118 |
83 |
$4K |
| D0272 |
Bitewings - two radiographic images |
444 |
437 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
46 |
25 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
14 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$312.00 |