| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,573 |
7,506 |
$334K |
| D0120 |
Periodic oral evaluation - established patient |
7,043 |
6,984 |
$237K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,467 |
6,432 |
$180K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
906 |
485 |
$94K |
| D0272 |
Bitewings - two radiographic images |
2,777 |
2,751 |
$85K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,480 |
1,359 |
$84K |
| D1351 |
Sealant - per tooth |
1,097 |
336 |
$42K |
| D1206 |
Topical application of fluoride varnish |
1,027 |
1,001 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
251 |
249 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
97 |
63 |
$10K |
| D0330 |
Panoramic radiographic image |
107 |
107 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
91 |
84 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
13 |
$1K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$564.48 |
| D1354 |
|
55 |
13 |
$493.14 |