| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,803 |
9,691 |
$259K |
| D1120 |
Prophylaxis - child |
7,248 |
7,122 |
$196K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,730 |
9,597 |
$163K |
| D1110 |
Prophylaxis - adult |
1,803 |
1,794 |
$71K |
| D0272 |
Bitewings - two radiographic images |
3,220 |
3,158 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,127 |
1,090 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
413 |
238 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
299 |
142 |
$31K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
178 |
55 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
530 |
513 |
$24K |
| D1351 |
Sealant - per tooth |
760 |
228 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
194 |
76 |
$13K |
| D0330 |
Panoramic radiographic image |
189 |
186 |
$10K |
| D1206 |
Topical application of fluoride varnish |
604 |
591 |
$10K |
| D0274 |
Bitewings - four radiographic images |
138 |
138 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
289 |
280 |
$4K |
| D9420 |
|
29 |
27 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
23 |
12 |
$418.11 |