| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,953 |
7,490 |
$298K |
| D0120 |
Periodic oral evaluation - established patient |
7,490 |
7,055 |
$192K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,896 |
7,450 |
$189K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,035 |
453 |
$104K |
| D1351 |
Sealant - per tooth |
1,826 |
982 |
$92K |
| D0272 |
Bitewings - two radiographic images |
3,587 |
3,350 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,128 |
1,006 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
451 |
212 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
972 |
886 |
$18K |
| D0330 |
Panoramic radiographic image |
536 |
493 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
164 |
132 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,335 |
1,185 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
550 |
453 |
$2K |
| D0274 |
Bitewings - four radiographic images |
27 |
27 |
$405.60 |
| D0140 |
Limited oral evaluation - problem focused |
30 |
30 |
$405.00 |