| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,824 |
4,655 |
$161K |
| D0120 |
Periodic oral evaluation - established patient |
5,951 |
5,752 |
$134K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,972 |
5,933 |
$116K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,992 |
6,758 |
$112K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,129 |
747 |
$82K |
| D0220 |
Intraoral - periapical first radiographic image |
6,490 |
6,218 |
$73K |
| D0274 |
Bitewings - four radiographic images |
2,878 |
2,781 |
$73K |
| D1110 |
Prophylaxis - adult |
1,316 |
1,274 |
$54K |
| D0272 |
Bitewings - two radiographic images |
2,027 |
1,939 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
567 |
384 |
$34K |
| D1353 |
|
1,552 |
563 |
$24K |
| D1351 |
Sealant - per tooth |
1,216 |
464 |
$24K |
| D0330 |
Panoramic radiographic image |
477 |
467 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
496 |
438 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
124 |
24 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
186 |
174 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
13 |
$1K |