| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,199 |
6,006 |
$255K |
| D0120 |
Periodic oral evaluation - established patient |
6,308 |
6,104 |
$177K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,293 |
5,129 |
$139K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,560 |
1,238 |
$126K |
| D1351 |
Sealant - per tooth |
1,386 |
1,032 |
$115K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,065 |
912 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
430 |
353 |
$46K |
| D0274 |
Bitewings - four radiographic images |
2,040 |
1,963 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,643 |
3,349 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
3,688 |
3,532 |
$22K |
| D0272 |
Bitewings - two radiographic images |
770 |
735 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
158 |
128 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
240 |
240 |
$6K |
| D1110 |
Prophylaxis - adult |
46 |
46 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
34 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
55 |
55 |
$2K |