| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,962 |
3,898 |
$182K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,577 |
4,501 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
3,422 |
3,372 |
$105K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
740 |
477 |
$99K |
| D1351 |
Sealant - per tooth |
2,432 |
385 |
$88K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
416 |
182 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,220 |
1,192 |
$66K |
| D7140 |
Extraction, erupted tooth or exposed root |
452 |
251 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
444 |
235 |
$46K |
| D1110 |
Prophylaxis - adult |
569 |
562 |
$36K |
| D3120 |
|
694 |
334 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
473 |
445 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,285 |
1,270 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
930 |
872 |
$18K |
| D8670 |
Periodic orthodontic treatment visit |
152 |
144 |
$11K |
| D0330 |
Panoramic radiographic image |
190 |
187 |
$8K |
| D0274 |
Bitewings - four radiographic images |
297 |
291 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
118 |
115 |
$1K |