| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,803 |
3,520 |
$97K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,119 |
680 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
4,040 |
3,763 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,485 |
4,160 |
$61K |
| D0330 |
Panoramic radiographic image |
860 |
749 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,902 |
1,427 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,996 |
1,804 |
$31K |
| D1351 |
Sealant - per tooth |
1,281 |
413 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
485 |
313 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
988 |
886 |
$19K |
| D1110 |
Prophylaxis - adult |
545 |
505 |
$17K |
| D1206 |
Topical application of fluoride varnish |
1,025 |
931 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
360 |
195 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
439 |
398 |
$8K |
| D0274 |
Bitewings - four radiographic images |
375 |
341 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
322 |
287 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
80 |
26 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
549 |
497 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
36 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
326 |
121 |
$3K |