| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,452 |
6,140 |
$190K |
| D0120 |
Periodic oral evaluation - established patient |
7,517 |
7,190 |
$155K |
| D1206 |
Topical application of fluoride varnish |
7,726 |
7,371 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,504 |
777 |
$125K |
| D1110 |
Prophylaxis - adult |
1,779 |
1,717 |
$66K |
| D0272 |
Bitewings - two radiographic images |
3,214 |
3,075 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,698 |
2,388 |
$37K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
320 |
171 |
$35K |
| D2932 |
|
286 |
110 |
$35K |
| D0330 |
Panoramic radiographic image |
884 |
849 |
$29K |
| D1351 |
Sealant - per tooth |
1,413 |
494 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,377 |
1,335 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
396 |
266 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
227 |
100 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
105 |
102 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
67 |
44 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
69 |
41 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
121 |
108 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
171 |
153 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
63 |
55 |
$2K |