| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,920 |
1,798 |
$285K |
| D0120 |
Periodic oral evaluation - established patient |
8,889 |
8,889 |
$252K |
| D1120 |
Prophylaxis - child |
6,201 |
6,200 |
$246K |
| D1110 |
Prophylaxis - adult |
2,958 |
2,955 |
$158K |
| D1351 |
Sealant - per tooth |
3,000 |
885 |
$108K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,224 |
7,223 |
$102K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,028 |
691 |
$79K |
| D1206 |
Topical application of fluoride varnish |
1,783 |
1,783 |
$51K |
| D0330 |
Panoramic radiographic image |
901 |
900 |
$45K |
| D0272 |
Bitewings - two radiographic images |
1,995 |
1,995 |
$41K |
| D0274 |
Bitewings - four radiographic images |
979 |
979 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
316 |
187 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
807 |
797 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
181 |
135 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
93 |
56 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
252 |
252 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
51 |
24 |
$5K |