| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,862 |
13,875 |
$372K |
| D0120 |
Periodic oral evaluation - established patient |
14,925 |
13,848 |
$361K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,488 |
1,755 |
$346K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,981 |
14,863 |
$242K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,058 |
2,779 |
$127K |
| D1351 |
Sealant - per tooth |
5,383 |
1,337 |
$124K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,683 |
1,007 |
$121K |
| D0272 |
Bitewings - two radiographic images |
6,122 |
5,704 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,422 |
661 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,890 |
1,755 |
$74K |
| D0140 |
Limited oral evaluation - problem focused |
2,127 |
1,915 |
$73K |
| D1110 |
Prophylaxis - adult |
2,082 |
1,878 |
$68K |
| D0240 |
|
3,060 |
1,514 |
$46K |
| D0330 |
Panoramic radiographic image |
734 |
688 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
832 |
768 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
101 |
63 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
614 |
234 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
34 |
14 |
$3K |
| D9420 |
|
19 |
13 |
$742.50 |