| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,916 |
9,529 |
$259K |
| D0120 |
Periodic oral evaluation - established patient |
12,228 |
11,854 |
$238K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,472 |
11,041 |
$171K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,708 |
1,196 |
$137K |
| D1110 |
Prophylaxis - adult |
3,367 |
3,257 |
$126K |
| D1999 |
|
8,574 |
7,147 |
$124K |
| D0330 |
Panoramic radiographic image |
1,858 |
1,745 |
$86K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,874 |
3,290 |
$80K |
| D0272 |
Bitewings - two radiographic images |
3,368 |
3,217 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
736 |
403 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
492 |
421 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,620 |
1,551 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,939 |
2,751 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,284 |
1,236 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,125 |
968 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
832 |
753 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
630 |
592 |
$17K |
| D1351 |
Sealant - per tooth |
651 |
192 |
$15K |
| D0240 |
|
417 |
339 |
$6K |