| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,067 |
5,820 |
$344K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,835 |
6,564 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
3,967 |
3,807 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,087 |
2,972 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,280 |
789 |
$83K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
727 |
443 |
$78K |
| D0330 |
Panoramic radiographic image |
912 |
892 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,117 |
769 |
$59K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,619 |
1,477 |
$57K |
| D1110 |
Prophylaxis - adult |
989 |
954 |
$56K |
| D0272 |
Bitewings - two radiographic images |
2,443 |
2,362 |
$50K |
| D1351 |
Sealant - per tooth |
2,049 |
504 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
638 |
414 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
921 |
875 |
$36K |
| D0274 |
Bitewings - four radiographic images |
864 |
834 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,082 |
1,040 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
316 |
185 |
$3K |