| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,303 |
8,005 |
$276K |
| D0120 |
Periodic oral evaluation - established patient |
7,757 |
7,478 |
$203K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,061 |
5,840 |
$111K |
| D0272 |
Bitewings - two radiographic images |
5,055 |
4,871 |
$102K |
| D1206 |
Topical application of fluoride varnish |
3,563 |
3,428 |
$87K |
| D1110 |
Prophylaxis - adult |
1,674 |
1,604 |
$75K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,292 |
1,173 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
876 |
840 |
$37K |
| D0145 |
Oral evaluation for a patient under three years of age |
560 |
543 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
173 |
72 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
266 |
160 |
$22K |
| D1351 |
Sealant - per tooth |
661 |
171 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,039 |
970 |
$14K |
| D9248 |
|
74 |
65 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
117 |
88 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
81 |
51 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
393 |
382 |
$5K |
| D1999 |
|
39 |
39 |
$135.00 |