| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,704 |
6,613 |
$185K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,179 |
1,329 |
$165K |
| D1206 |
Topical application of fluoride varnish |
7,475 |
7,365 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
6,505 |
6,417 |
$105K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,316 |
862 |
$89K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,959 |
2,720 |
$87K |
| D0272 |
Bitewings - two radiographic images |
2,520 |
2,491 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,065 |
1,056 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
3,052 |
2,940 |
$31K |
| D1110 |
Prophylaxis - adult |
849 |
838 |
$28K |
| D1351 |
Sealant - per tooth |
1,022 |
378 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,148 |
1,956 |
$24K |
| D0274 |
Bitewings - four radiographic images |
466 |
459 |
$11K |
| D0330 |
Panoramic radiographic image |
119 |
119 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
73 |
51 |
$5K |
| D3120 |
|
259 |
168 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
88 |
52 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
96 |
93 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
36 |
32 |
$1K |
| D0240 |
|
26 |
24 |
$319.02 |