| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,626 |
4,607 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
5,057 |
5,035 |
$116K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,994 |
1,782 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,120 |
844 |
$77K |
| D1351 |
Sealant - per tooth |
2,580 |
599 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,368 |
3,350 |
$66K |
| D1110 |
Prophylaxis - adult |
1,266 |
1,262 |
$51K |
| D1206 |
Topical application of fluoride varnish |
2,040 |
2,032 |
$44K |
| D0272 |
Bitewings - two radiographic images |
2,292 |
2,284 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
641 |
552 |
$37K |
| D0274 |
Bitewings - four radiographic images |
912 |
909 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
385 |
279 |
$28K |
| D0602 |
|
2,200 |
2,200 |
$22K |
| D1330 |
|
4,138 |
4,129 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,383 |
1,369 |
$13K |
| D0603 |
|
1,210 |
1,205 |
$12K |
| D1310 |
|
1,742 |
1,742 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
851 |
811 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
336 |
333 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
52 |
30 |
$5K |
| D0330 |
Panoramic radiographic image |
109 |
109 |
$5K |
| D0601 |
|
402 |
399 |
$4K |
| D9110 |
|
75 |
72 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
105 |
104 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
13 |
$1K |