| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,038 |
3,551 |
$90K |
| D1120 |
Prophylaxis - child |
2,325 |
2,009 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,620 |
3,185 |
$49K |
| D1110 |
Prophylaxis - adult |
1,219 |
1,090 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
303 |
121 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
643 |
514 |
$24K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
148 |
63 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,116 |
998 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
256 |
225 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
115 |
53 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
168 |
160 |
$2K |
| D1351 |
Sealant - per tooth |
88 |
30 |
$2K |