| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
20,200 |
19,425 |
$844K |
| D0120 |
Periodic oral evaluation - established patient |
19,133 |
18,329 |
$601K |
| D1206 |
Topical application of fluoride varnish |
17,732 |
17,022 |
$462K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,930 |
1,268 |
$188K |
| D0272 |
Bitewings - two radiographic images |
5,418 |
5,218 |
$158K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,989 |
1,830 |
$107K |
| D1351 |
Sealant - per tooth |
2,546 |
752 |
$90K |
| D0330 |
Panoramic radiographic image |
1,078 |
1,012 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
402 |
239 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
480 |
468 |
$29K |
| D0274 |
Bitewings - four radiographic images |
587 |
563 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
741 |
711 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
219 |
147 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
257 |
244 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
159 |
122 |
$2K |
| D1999 |
|
1,174 |
1,140 |
$0.00 |
| D9996 |
|
16 |
16 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |
| D0603 |
|
30 |
29 |
$0.00 |