| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,664 |
9,645 |
$394K |
| D1354 |
|
7,710 |
1,673 |
$382K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,345 |
11,161 |
$245K |
| D0120 |
Periodic oral evaluation - established patient |
10,267 |
9,230 |
$244K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,922 |
921 |
$183K |
| D1351 |
Sealant - per tooth |
3,851 |
1,158 |
$116K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,163 |
1,921 |
$92K |
| D0272 |
Bitewings - two radiographic images |
3,650 |
3,265 |
$84K |
| D1110 |
Prophylaxis - adult |
1,568 |
1,420 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
4,494 |
4,030 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
754 |
397 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,794 |
2,369 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
1,446 |
1,279 |
$47K |
| D0330 |
Panoramic radiographic image |
674 |
607 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
518 |
284 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
798 |
762 |
$27K |
| D0145 |
Oral evaluation for a patient under three years of age |
776 |
720 |
$20K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
163 |
54 |
$16K |
| D0274 |
Bitewings - four radiographic images |
461 |
419 |
$14K |
| D7962 |
|
151 |
122 |
$10K |
| D9420 |
|
149 |
142 |
$7K |
| D7961 |
|
66 |
45 |
$4K |
| D7960 |
|
23 |
12 |
$2K |
| D2332 |
|
23 |
13 |
$2K |
| D0270 |
|
81 |
68 |
$1K |
| D7922 |
|
47 |
27 |
$775.50 |
| D1999 |
|
845 |
580 |
$0.00 |
| D9986 |
|
178 |
178 |
$0.00 |