| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,162 |
7,057 |
$327K |
| D0120 |
Periodic oral evaluation - established patient |
8,931 |
8,815 |
$274K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,106 |
971 |
$274K |
| D1351 |
Sealant - per tooth |
7,413 |
2,058 |
$259K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,871 |
6,786 |
$160K |
| D1110 |
Prophylaxis - adult |
2,362 |
2,329 |
$148K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
939 |
554 |
$93K |
| D0272 |
Bitewings - two radiographic images |
5,532 |
5,455 |
$89K |
| D1206 |
Topical application of fluoride varnish |
2,713 |
2,660 |
$67K |
| D0274 |
Bitewings - four radiographic images |
2,257 |
2,225 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
409 |
252 |
$46K |
| D0330 |
Panoramic radiographic image |
919 |
901 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,610 |
1,512 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
548 |
535 |
$30K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
147 |
83 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
147 |
91 |
$23K |
| D1330 |
|
3,662 |
3,606 |
$22K |
| D8670 |
Periodic orthodontic treatment visit |
296 |
285 |
$22K |
| D9248 |
|
92 |
85 |
$17K |
| D3120 |
|
497 |
261 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
181 |
173 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
58 |
54 |
$519.15 |