| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,364 |
5,997 |
$229K |
| D0120 |
Periodic oral evaluation - established patient |
6,193 |
5,850 |
$170K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,335 |
780 |
$157K |
| D1206 |
Topical application of fluoride varnish |
7,019 |
6,607 |
$133K |
| D1351 |
Sealant - per tooth |
3,591 |
855 |
$103K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,695 |
1,484 |
$84K |
| D0274 |
Bitewings - four radiographic images |
2,126 |
2,001 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
608 |
343 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
773 |
688 |
$32K |
| D1110 |
Prophylaxis - adult |
580 |
547 |
$30K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
156 |
52 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
217 |
112 |
$20K |
| D0272 |
Bitewings - two radiographic images |
608 |
572 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
313 |
295 |
$13K |
| D0330 |
Panoramic radiographic image |
144 |
139 |
$10K |
| D0240 |
|
255 |
118 |
$4K |
| D1354 |
|
68 |
26 |
$1K |
| D9420 |
|
13 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
73 |
67 |
$1K |