| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
30,714 |
30,129 |
$1.33M |
| D0120 |
Periodic oral evaluation - established patient |
24,935 |
24,482 |
$823K |
| D1208 |
Topical application of fluoride, excluding varnish |
29,738 |
29,160 |
$812K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,494 |
3,867 |
$663K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,909 |
7,677 |
$498K |
| D0272 |
Bitewings - two radiographic images |
9,053 |
8,895 |
$271K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,463 |
1,561 |
$260K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,992 |
2,267 |
$254K |
| D0330 |
Panoramic radiographic image |
3,146 |
3,085 |
$243K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,188 |
630 |
$223K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,564 |
3,516 |
$220K |
| D1351 |
Sealant - per tooth |
3,803 |
1,009 |
$141K |
| D0274 |
Bitewings - four radiographic images |
2,793 |
2,753 |
$126K |
| D0140 |
Limited oral evaluation - problem focused |
1,876 |
1,823 |
$85K |
| D0220 |
Intraoral - periapical first radiographic image |
920 |
894 |
$16K |
| D8670 |
Periodic orthodontic treatment visit |
103 |
103 |
$9K |