| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,335 |
3,138 |
$87K |
| D1351 |
Sealant - per tooth |
2,880 |
682 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
3,113 |
2,933 |
$78K |
| D1206 |
Topical application of fluoride varnish |
4,219 |
3,972 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
486 |
358 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,063 |
1,037 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
616 |
453 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
923 |
884 |
$43K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
304 |
196 |
$43K |
| D1110 |
Prophylaxis - adult |
858 |
832 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,463 |
1,410 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
384 |
251 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
488 |
469 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,058 |
1,008 |
$16K |
| D0274 |
Bitewings - four radiographic images |
434 |
419 |
$13K |
| D2940 |
|
325 |
172 |
$13K |
| D0330 |
Panoramic radiographic image |
198 |
193 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
974 |
430 |
$11K |
| D0240 |
|
14 |
12 |
$233.94 |