| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
28,967 |
28,411 |
$1.23M |
| D1208 |
Topical application of fluoride, excluding varnish |
28,419 |
27,878 |
$762K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,118 |
3,826 |
$522K |
| D0120 |
Periodic oral evaluation - established patient |
15,682 |
15,415 |
$515K |
| D0272 |
Bitewings - two radiographic images |
11,083 |
10,872 |
$335K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,330 |
2,495 |
$286K |
| D1351 |
Sealant - per tooth |
7,093 |
2,169 |
$258K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,680 |
3,502 |
$211K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,626 |
2,536 |
$157K |
| D0330 |
Panoramic radiographic image |
672 |
661 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,040 |
1,028 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
412 |
322 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
2,340 |
2,269 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
874 |
856 |
$40K |
| D0602 |
|
671 |
662 |
$14K |
| D0191 |
|
463 |
440 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
24 |
$4K |
| D0601 |
|
132 |
132 |
$3K |
| D2332 |
|
14 |
12 |
$2K |
| D0603 |
|
62 |
59 |
$1K |