| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,104 |
4,047 |
$169K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,240 |
796 |
$146K |
| D1351 |
Sealant - per tooth |
3,876 |
977 |
$127K |
| D1206 |
Topical application of fluoride varnish |
4,958 |
4,886 |
$120K |
| D0120 |
Periodic oral evaluation - established patient |
3,941 |
3,878 |
$111K |
| D7140 |
Extraction, erupted tooth or exposed root |
765 |
445 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
750 |
741 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
804 |
761 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,849 |
1,622 |
$33K |
| D0272 |
Bitewings - two radiographic images |
2,138 |
2,101 |
$31K |
| D1110 |
Prophylaxis - adult |
433 |
428 |
$24K |
| D0330 |
Panoramic radiographic image |
557 |
543 |
$23K |
| D3120 |
|
529 |
373 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
180 |
123 |
$17K |
| D1330 |
|
2,799 |
2,757 |
$16K |
| D0274 |
Bitewings - four radiographic images |
663 |
655 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
51 |
42 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
487 |
476 |
$4K |
| D0240 |
|
222 |
217 |
$3K |