| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,228 |
3,112 |
$68K |
| D1206 |
Topical application of fluoride varnish |
3,776 |
3,661 |
$64K |
| D1120 |
Prophylaxis - child |
2,063 |
1,994 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
869 |
285 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
449 |
268 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
820 |
473 |
$48K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
267 |
61 |
$32K |
| D1110 |
Prophylaxis - adult |
572 |
548 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,668 |
1,619 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
884 |
852 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,430 |
1,155 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
472 |
458 |
$14K |
| D0272 |
Bitewings - two radiographic images |
617 |
599 |
$11K |
| D0330 |
Panoramic radiographic image |
183 |
172 |
$9K |
| D0274 |
Bitewings - four radiographic images |
170 |
162 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
87 |
80 |
$3K |
| D0603 |
|
270 |
270 |
$2K |
| D1351 |
Sealant - per tooth |
80 |
28 |
$2K |
| D3120 |
|
40 |
25 |
$1K |