| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,368 |
9,229 |
$386K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,354 |
8,223 |
$218K |
| D0120 |
Periodic oral evaluation - established patient |
7,038 |
6,946 |
$198K |
| D1351 |
Sealant - per tooth |
2,247 |
1,157 |
$143K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,048 |
1,635 |
$127K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,543 |
1,394 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,676 |
2,618 |
$62K |
| D0272 |
Bitewings - two radiographic images |
3,890 |
3,811 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
5,852 |
5,661 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
813 |
695 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
480 |
401 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,980 |
4,790 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
198 |
170 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
876 |
843 |
$16K |
| D1206 |
Topical application of fluoride varnish |
524 |
522 |
$14K |
| D0274 |
Bitewings - four radiographic images |
777 |
767 |
$14K |