| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,004 |
6,897 |
$317K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,623 |
840 |
$216K |
| D1206 |
Topical application of fluoride varnish |
6,779 |
6,649 |
$168K |
| D0120 |
Periodic oral evaluation - established patient |
5,358 |
5,283 |
$164K |
| D1351 |
Sealant - per tooth |
3,242 |
611 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,944 |
1,903 |
$103K |
| D7140 |
Extraction, erupted tooth or exposed root |
572 |
333 |
$68K |
| D0330 |
Panoramic radiographic image |
989 |
973 |
$44K |
| D0272 |
Bitewings - two radiographic images |
2,731 |
2,684 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,927 |
1,769 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
779 |
759 |
$36K |
| D1110 |
Prophylaxis - adult |
515 |
502 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,331 |
1,331 |
$32K |
| D1330 |
|
4,150 |
4,082 |
$27K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
26 |
12 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
69 |
66 |
$3K |
| D0274 |
Bitewings - four radiographic images |
82 |
82 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$2K |