| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,080 |
8,026 |
$213K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,463 |
1,476 |
$172K |
| D1206 |
Topical application of fluoride varnish |
9,579 |
9,515 |
$155K |
| D0120 |
Periodic oral evaluation - established patient |
7,461 |
7,410 |
$114K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
823 |
355 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,422 |
750 |
$79K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,607 |
2,416 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,267 |
2,250 |
$58K |
| D1110 |
Prophylaxis - adult |
1,457 |
1,447 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,373 |
3,802 |
$46K |
| D1351 |
Sealant - per tooth |
1,497 |
452 |
$45K |
| D0272 |
Bitewings - two radiographic images |
2,966 |
2,944 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
4,489 |
4,407 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
647 |
490 |
$32K |
| D9920 |
|
538 |
525 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,083 |
1,074 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
1,014 |
984 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
657 |
517 |
$12K |
| D9248 |
|
13 |
13 |
$1K |
| D0240 |
|
114 |
59 |
$1K |
| D0330 |
Panoramic radiographic image |
77 |
76 |
$1K |