| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,794 |
7,578 |
$311K |
| D0120 |
Periodic oral evaluation - established patient |
6,010 |
5,815 |
$181K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,077 |
5,902 |
$154K |
| D0272 |
Bitewings - two radiographic images |
2,364 |
2,301 |
$67K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
639 |
475 |
$60K |
| D1351 |
Sealant - per tooth |
1,508 |
484 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
864 |
771 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
671 |
648 |
$39K |
| D0330 |
Panoramic radiographic image |
519 |
498 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,538 |
1,478 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
328 |
191 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
342 |
273 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
601 |
575 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
846 |
479 |
$13K |
| D0274 |
Bitewings - four radiographic images |
247 |
237 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
602 |
568 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
47 |
25 |
$9K |
| D1110 |
Prophylaxis - adult |
14 |
12 |
$66.56 |
| D9215 |
|
48 |
44 |
$0.00 |
| D1999 |
|
2,105 |
1,956 |
$0.00 |