| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,861 |
7,725 |
$331K |
| D1206 |
Topical application of fluoride varnish |
8,414 |
8,262 |
$291K |
| D0120 |
Periodic oral evaluation - established patient |
6,357 |
6,219 |
$131K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
860 |
602 |
$91K |
| D1351 |
Sealant - per tooth |
2,722 |
836 |
$90K |
| D0272 |
Bitewings - two radiographic images |
2,916 |
2,856 |
$70K |
| D0240 |
|
1,437 |
1,408 |
$67K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
463 |
271 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,571 |
1,562 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
665 |
484 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
562 |
336 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,330 |
1,232 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,624 |
2,536 |
$39K |
| D0330 |
Panoramic radiographic image |
480 |
472 |
$29K |
| D1110 |
Prophylaxis - adult |
456 |
440 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,063 |
2,008 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
349 |
331 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
361 |
359 |
$11K |
| D0274 |
Bitewings - four radiographic images |
159 |
159 |
$5K |
| D1354 |
|
118 |
54 |
$3K |
| D7111 |
|
22 |
14 |
$1K |