| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,176 |
6,089 |
$316K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,649 |
894 |
$186K |
| D1206 |
Topical application of fluoride varnish |
6,475 |
6,381 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
4,585 |
4,526 |
$134K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,842 |
1,804 |
$106K |
| D0272 |
Bitewings - two radiographic images |
2,608 |
2,566 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
3,138 |
3,033 |
$61K |
| D9110 |
|
787 |
760 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
638 |
381 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,249 |
2,555 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,104 |
1,890 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
391 |
197 |
$40K |
| D1351 |
Sealant - per tooth |
922 |
280 |
$37K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
331 |
170 |
$28K |
| D1110 |
Prophylaxis - adult |
95 |
95 |
$6K |
| D2140 |
|
18 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$637.00 |