| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,928 |
7,696 |
$325K |
| D0120 |
Periodic oral evaluation - established patient |
9,479 |
9,198 |
$264K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,143 |
1,577 |
$247K |
| D1206 |
Topical application of fluoride varnish |
10,452 |
10,152 |
$247K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,618 |
1,967 |
$233K |
| D1351 |
Sealant - per tooth |
4,509 |
2,092 |
$142K |
| D1110 |
Prophylaxis - adult |
2,297 |
2,232 |
$129K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,009 |
4,555 |
$88K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
399 |
267 |
$61K |
| D0272 |
Bitewings - two radiographic images |
3,598 |
3,495 |
$52K |
| D0330 |
Panoramic radiographic image |
929 |
911 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
279 |
180 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,118 |
1,087 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
414 |
399 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
307 |
304 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
389 |
373 |
$3K |
| D0240 |
|
13 |
13 |
$117.00 |