| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,867 |
8,261 |
$359K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,345 |
7,756 |
$213K |
| D0120 |
Periodic oral evaluation - established patient |
7,201 |
6,529 |
$209K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
881 |
476 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,327 |
1,239 |
$76K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,495 |
1,316 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
962 |
604 |
$70K |
| D0272 |
Bitewings - two radiographic images |
2,289 |
2,144 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
675 |
650 |
$30K |
| D1351 |
Sealant - per tooth |
762 |
219 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
239 |
119 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,476 |
1,321 |
$25K |
| D0274 |
Bitewings - four radiographic images |
490 |
430 |
$20K |
| D0330 |
Panoramic radiographic image |
263 |
244 |
$20K |
| D1206 |
Topical application of fluoride varnish |
235 |
235 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
250 |
116 |
$4K |
| D1999 |
|
324 |
268 |
$0.00 |
| D1330 |
|
4,037 |
3,677 |
$0.00 |