| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,867 |
5,837 |
$218K |
| D0120 |
Periodic oral evaluation - established patient |
4,700 |
4,696 |
$118K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
841 |
263 |
$108K |
| D1206 |
Topical application of fluoride varnish |
3,921 |
3,869 |
$91K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
578 |
275 |
$75K |
| D0350 |
|
1,290 |
996 |
$70K |
| D1351 |
Sealant - per tooth |
1,729 |
509 |
$64K |
| D0272 |
Bitewings - two radiographic images |
2,867 |
2,861 |
$61K |
| D1110 |
Prophylaxis - adult |
894 |
893 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,273 |
3,268 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,215 |
1,202 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
853 |
853 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,902 |
2,881 |
$38K |
| D0240 |
|
1,622 |
1,611 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
311 |
193 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
288 |
184 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,219 |
1,219 |
$22K |
| D8660 |
|
77 |
77 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
344 |
344 |
$11K |
| D1354 |
|
377 |
116 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
115 |
114 |
$7K |
| D0274 |
Bitewings - four radiographic images |
118 |
118 |
$4K |
| D9219 |
|
79 |
79 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
70 |
70 |
$2K |
| D0340 |
|
31 |
31 |
$2K |
| D0170 |
|
50 |
50 |
$2K |