| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,157 |
9,013 |
$383K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,822 |
1,750 |
$341K |
| D1206 |
Topical application of fluoride varnish |
11,025 |
10,859 |
$270K |
| D0120 |
Periodic oral evaluation - established patient |
8,865 |
8,738 |
$258K |
| D1351 |
Sealant - per tooth |
5,523 |
1,121 |
$181K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,008 |
1,976 |
$105K |
| D0140 |
Limited oral evaluation - problem focused |
2,420 |
2,329 |
$105K |
| D7140 |
Extraction, erupted tooth or exposed root |
877 |
470 |
$90K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
590 |
308 |
$89K |
| D0272 |
Bitewings - two radiographic images |
4,713 |
4,631 |
$71K |
| D0330 |
Panoramic radiographic image |
1,617 |
1,588 |
$69K |
| D1110 |
Prophylaxis - adult |
948 |
941 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,498 |
2,060 |
$45K |
| D9248 |
|
242 |
215 |
$45K |
| D1330 |
|
3,947 |
3,892 |
$23K |
| D3120 |
|
609 |
371 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
138 |
108 |
$20K |
| D0240 |
|
1,152 |
1,135 |
$19K |
| D0274 |
Bitewings - four radiographic images |
664 |
660 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
168 |
166 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
393 |
384 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
26 |
$3K |