| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,245 |
6,100 |
$231K |
| D0120 |
Periodic oral evaluation - established patient |
6,692 |
6,555 |
$192K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,473 |
764 |
$130K |
| D1110 |
Prophylaxis - adult |
2,540 |
2,498 |
$125K |
| D1206 |
Topical application of fluoride varnish |
4,109 |
4,030 |
$112K |
| D1351 |
Sealant - per tooth |
3,623 |
1,126 |
$111K |
| D0272 |
Bitewings - two radiographic images |
3,838 |
3,760 |
$84K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,971 |
3,890 |
$78K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,190 |
1,169 |
$65K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,274 |
1,125 |
$44K |
| D0330 |
Panoramic radiographic image |
704 |
692 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
805 |
787 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,011 |
1,904 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
428 |
303 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,036 |
579 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
89 |
42 |
$14K |
| D1354 |
|
689 |
186 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
104 |
53 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
383 |
363 |
$5K |
| D9248 |
|
37 |
26 |
$5K |
| D9920 |
|
61 |
38 |
$2K |