| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,184 |
5,962 |
$262K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,668 |
5,456 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
4,435 |
4,298 |
$145K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,659 |
1,579 |
$97K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,151 |
1,020 |
$62K |
| D0272 |
Bitewings - two radiographic images |
1,847 |
1,778 |
$54K |
| D0330 |
Panoramic radiographic image |
807 |
781 |
$51K |
| D1351 |
Sealant - per tooth |
1,462 |
330 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
407 |
247 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
415 |
398 |
$19K |
| D1206 |
Topical application of fluoride varnish |
460 |
455 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
509 |
483 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
70 |
41 |
$7K |
| D0240 |
|
310 |
282 |
$5K |
| D0274 |
Bitewings - four radiographic images |
69 |
68 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27 |
13 |
$416.50 |