| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,950 |
2,934 |
$174K |
| D0120 |
Periodic oral evaluation - established patient |
2,952 |
2,932 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
651 |
452 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,966 |
1,948 |
$36K |
| D0330 |
Panoramic radiographic image |
449 |
448 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
781 |
760 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,183 |
1,179 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
323 |
220 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,317 |
1,314 |
$24K |
| D1110 |
Prophylaxis - adult |
357 |
354 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
410 |
409 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
210 |
167 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
709 |
692 |
$9K |
| D1351 |
Sealant - per tooth |
380 |
141 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
180 |
177 |
$8K |
| D0274 |
Bitewings - four radiographic images |
231 |
227 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
411 |
315 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
19 |
13 |
$2K |