| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,534 |
3,482 |
$191K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,465 |
2,441 |
$78K |
| D1206 |
Topical application of fluoride varnish |
4,348 |
4,282 |
$74K |
| D7140 |
Extraction, erupted tooth or exposed root |
906 |
412 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
981 |
524 |
$56K |
| D1110 |
Prophylaxis - adult |
863 |
846 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,970 |
1,925 |
$42K |
| D0330 |
Panoramic radiographic image |
585 |
577 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,604 |
1,579 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
862 |
842 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
555 |
352 |
$26K |
| D1351 |
Sealant - per tooth |
1,214 |
354 |
$24K |
| D0274 |
Bitewings - four radiographic images |
702 |
693 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
113 |
55 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
520 |
502 |
$6K |
| D9248 |
|
62 |
61 |
$2K |