| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,885 |
2,763 |
$143K |
| D0120 |
Periodic oral evaluation - established patient |
3,345 |
3,207 |
$105K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
684 |
362 |
$78K |
| D1351 |
Sealant - per tooth |
2,475 |
514 |
$73K |
| D1206 |
Topical application of fluoride varnish |
2,721 |
2,610 |
$66K |
| D1110 |
Prophylaxis - adult |
826 |
800 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
417 |
211 |
$42K |
| D0272 |
Bitewings - two radiographic images |
1,263 |
1,216 |
$40K |
| D1354 |
|
1,325 |
454 |
$32K |
| D0330 |
Panoramic radiographic image |
335 |
322 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
274 |
178 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
372 |
361 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
609 |
548 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
395 |
370 |
$21K |
| D0274 |
Bitewings - four radiographic images |
374 |
362 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
683 |
659 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
58 |
12 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
408 |
283 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
15 |
$783.94 |