| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,552 |
4,491 |
$199K |
| D0120 |
Periodic oral evaluation - established patient |
4,612 |
4,528 |
$140K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,089 |
3,009 |
$73K |
| D0274 |
Bitewings - four radiographic images |
1,559 |
1,514 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
568 |
345 |
$56K |
| D1206 |
Topical application of fluoride varnish |
2,041 |
1,998 |
$55K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
382 |
238 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
508 |
503 |
$31K |
| D0272 |
Bitewings - two radiographic images |
740 |
738 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
586 |
564 |
$19K |
| D1110 |
Prophylaxis - adult |
561 |
521 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,038 |
1,016 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
115 |
75 |
$10K |
| D1351 |
Sealant - per tooth |
198 |
60 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
55 |
39 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
25 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
16 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$764.40 |
| D0230 |
Intraoral - periapical each additional radiographic image |
33 |
28 |
$384.54 |