| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,436 |
2,412 |
$130K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
671 |
415 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
2,318 |
2,312 |
$106K |
| D0277 |
|
1,184 |
1,177 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,266 |
2,243 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
368 |
215 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,231 |
1,093 |
$45K |
| D1351 |
Sealant - per tooth |
354 |
113 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
50 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
91 |
88 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
80 |
80 |
$6K |
| D0602 |
|
688 |
687 |
$5K |
| D0603 |
|
346 |
343 |
$3K |
| D0601 |
|
246 |
245 |
$2K |