| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,926 |
8,701 |
$363K |
| D0120 |
Periodic oral evaluation - established patient |
8,455 |
8,250 |
$237K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,245 |
8,024 |
$212K |
| D1351 |
Sealant - per tooth |
2,348 |
1,372 |
$120K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,927 |
1,618 |
$111K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,155 |
1,966 |
$102K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,778 |
1,551 |
$64K |
| D0274 |
Bitewings - four radiographic images |
1,538 |
1,490 |
$28K |
| D0272 |
Bitewings - two radiographic images |
2,435 |
2,385 |
$24K |
| D1206 |
Topical application of fluoride varnish |
733 |
732 |
$19K |
| D0330 |
Panoramic radiographic image |
745 |
731 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
294 |
260 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
703 |
682 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
79 |
71 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
682 |
665 |
$4K |
| D1354 |
|
117 |
61 |
$3K |
| D9110 |
|
49 |
49 |
$3K |
| D1110 |
Prophylaxis - adult |
69 |
69 |
$484.21 |
| D0230 |
Intraoral - periapical each additional radiographic image |
60 |
56 |
$282.14 |
| D0603 |
|
12 |
12 |
$112.50 |
| D0602 |
|
209 |
209 |
$112.50 |
| D0601 |
|
128 |
128 |
$22.50 |