| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,733 |
6,652 |
$207K |
| D0120 |
Periodic oral evaluation - established patient |
8,521 |
8,420 |
$178K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,157 |
8,049 |
$131K |
| D0272 |
Bitewings - two radiographic images |
3,004 |
2,971 |
$59K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,156 |
2,040 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
576 |
278 |
$57K |
| D1110 |
Prophylaxis - adult |
1,285 |
1,259 |
$51K |
| D1999 |
|
3,945 |
3,610 |
$29K |
| D0330 |
Panoramic radiographic image |
380 |
372 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
207 |
109 |
$14K |
| D1206 |
Topical application of fluoride varnish |
482 |
471 |
$9K |
| D1351 |
Sealant - per tooth |
345 |
100 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
661 |
636 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
129 |
126 |
$5K |
| D0274 |
Bitewings - four radiographic images |
138 |
133 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
15 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
41 |
38 |
$1K |