| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,090 |
2,072 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,460 |
2,439 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
2,095 |
2,083 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
319 |
223 |
$24K |
| D1351 |
Sealant - per tooth |
603 |
184 |
$22K |
| D1110 |
Prophylaxis - adult |
386 |
383 |
$16K |
| D0272 |
Bitewings - two radiographic images |
885 |
876 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
83 |
63 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
359 |
349 |
$12K |
| D1330 |
|
2,168 |
2,149 |
$12K |
| D1310 |
|
2,171 |
2,151 |
$12K |
| D1320 |
|
754 |
748 |
$11K |
| D0603 |
|
1,122 |
1,115 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
335 |
329 |
$7K |
| D1354 |
|
772 |
268 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
116 |
69 |
$6K |
| D0330 |
Panoramic radiographic image |
144 |
143 |
$6K |
| D0274 |
Bitewings - four radiographic images |
164 |
163 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
85 |
55 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
379 |
365 |
$3K |
| D0602 |
|
297 |
295 |
$3K |
| D0601 |
|
155 |
152 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
50 |
50 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
105 |
97 |
$1K |