| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,408 |
11,039 |
$482K |
| D0120 |
Periodic oral evaluation - established patient |
9,780 |
9,454 |
$318K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,421 |
8,160 |
$226K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,622 |
1,212 |
$170K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,222 |
2,070 |
$125K |
| D0272 |
Bitewings - two radiographic images |
3,434 |
3,322 |
$102K |
| D1351 |
Sealant - per tooth |
2,633 |
977 |
$98K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,101 |
915 |
$95K |
| D1206 |
Topical application of fluoride varnish |
2,787 |
2,666 |
$72K |
| D0330 |
Panoramic radiographic image |
871 |
852 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
373 |
269 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
637 |
612 |
$38K |
| D0274 |
Bitewings - four radiographic images |
726 |
712 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,773 |
1,711 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
628 |
598 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
485 |
313 |
$8K |
| D0240 |
|
124 |
113 |
$2K |
| D1999 |
|
138 |
132 |
$0.00 |
| D9215 |
|
500 |
463 |
$0.00 |