| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,656 |
4,572 |
$230K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,119 |
5,031 |
$145K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,842 |
1,041 |
$115K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
821 |
407 |
$84K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,617 |
753 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,357 |
801 |
$66K |
| D1206 |
Topical application of fluoride varnish |
4,540 |
4,478 |
$65K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,555 |
1,494 |
$57K |
| D0272 |
Bitewings - two radiographic images |
2,754 |
2,706 |
$47K |
| D1351 |
Sealant - per tooth |
1,893 |
563 |
$36K |
| D1110 |
Prophylaxis - adult |
711 |
696 |
$34K |
| D0330 |
Panoramic radiographic image |
590 |
585 |
$23K |
| D0274 |
Bitewings - four radiographic images |
761 |
754 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
958 |
939 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
452 |
428 |
$5K |
| D9248 |
|
122 |
117 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
58 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
272 |
269 |
$391.70 |
| D0230 |
Intraoral - periapical each additional radiographic image |
27 |
13 |
$164.44 |