| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,162 |
2,974 |
$158K |
| D1206 |
Topical application of fluoride varnish |
3,167 |
2,984 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,998 |
1,871 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
980 |
903 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,411 |
1,314 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,767 |
973 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
468 |
421 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,381 |
1,279 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
219 |
139 |
$14K |
| D0330 |
Panoramic radiographic image |
251 |
239 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
74 |
12 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
188 |
167 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
26 |
$2K |
| D1351 |
Sealant - per tooth |
62 |
18 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
43 |
40 |
$1K |