| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,838 |
13,728 |
$609K |
| D0120 |
Periodic oral evaluation - established patient |
13,623 |
13,505 |
$604K |
| D1206 |
Topical application of fluoride varnish |
8,900 |
8,793 |
$280K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,361 |
1,172 |
$256K |
| D0272 |
Bitewings - two radiographic images |
7,711 |
7,644 |
$227K |
| D1351 |
Sealant - per tooth |
5,094 |
871 |
$223K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,205 |
5,190 |
$116K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,338 |
2,984 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
3,471 |
3,414 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,036 |
1,029 |
$46K |
| D0603 |
|
5,442 |
5,385 |
$44K |
| D1110 |
Prophylaxis - adult |
778 |
773 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,128 |
1,116 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,807 |
2,138 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
289 |
214 |
$26K |
| D0602 |
|
3,005 |
2,980 |
$25K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
75 |
24 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$540.00 |