| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,314 |
11,177 |
$312K |
| D1120 |
Prophylaxis - child |
8,083 |
7,962 |
$296K |
| D1206 |
Topical application of fluoride varnish |
11,506 |
11,335 |
$227K |
| D1110 |
Prophylaxis - adult |
2,126 |
2,098 |
$114K |
| D1351 |
Sealant - per tooth |
3,281 |
880 |
$105K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,939 |
1,776 |
$103K |
| D0272 |
Bitewings - two radiographic images |
3,200 |
3,161 |
$79K |
| D4346 |
|
781 |
773 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
367 |
267 |
$44K |
| D0274 |
Bitewings - four radiographic images |
995 |
984 |
$36K |
| D1354 |
|
1,093 |
294 |
$24K |
| D0330 |
Panoramic radiographic image |
363 |
358 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
187 |
179 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
76 |
62 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
62 |
27 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
22 |
19 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
197 |
171 |
$3K |
| D0240 |
|
106 |
51 |
$2K |
| D1330 |
|
14 |
14 |
$273.00 |