| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,365 |
3,236 |
$87K |
| D1120 |
Prophylaxis - child |
2,778 |
2,675 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,452 |
3,320 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
481 |
274 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
942 |
828 |
$43K |
| D1110 |
Prophylaxis - adult |
852 |
826 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,050 |
1,002 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
262 |
258 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
551 |
526 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
102 |
72 |
$8K |
| D1351 |
Sealant - per tooth |
285 |
74 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
51 |
14 |
$8K |
| D0274 |
Bitewings - four radiographic images |
220 |
218 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
81 |
41 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
124 |
120 |
$5K |
| D0330 |
Panoramic radiographic image |
42 |
41 |
$2K |
| D9420 |
|
17 |
17 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
91 |
56 |
$1K |