| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,223 |
7,909 |
$370K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,597 |
9,215 |
$246K |
| D0120 |
Periodic oral evaluation - established patient |
8,937 |
8,584 |
$229K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,315 |
873 |
$135K |
| D1110 |
Prophylaxis - adult |
1,720 |
1,638 |
$101K |
| D1351 |
Sealant - per tooth |
2,825 |
935 |
$95K |
| D0272 |
Bitewings - two radiographic images |
3,035 |
2,904 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
837 |
450 |
$74K |
| D8670 |
Periodic orthodontic treatment visit |
472 |
418 |
$68K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
763 |
474 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
672 |
512 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,807 |
2,450 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,419 |
1,364 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
882 |
856 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,038 |
977 |
$42K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
109 |
62 |
$19K |
| D0330 |
Panoramic radiographic image |
250 |
232 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
585 |
555 |
$10K |
| D1354 |
|
607 |
290 |
$8K |
| D8660 |
|
172 |
167 |
$5K |