| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,226 |
7,039 |
$351K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,150 |
1,500 |
$208K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,088 |
5,932 |
$162K |
| D1206 |
Topical application of fluoride varnish |
7,261 |
7,095 |
$106K |
| D9248 |
|
1,073 |
1,026 |
$72K |
| D0272 |
Bitewings - two radiographic images |
3,709 |
3,611 |
$65K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,012 |
1,893 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
2,307 |
2,252 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
882 |
600 |
$47K |
| D1110 |
Prophylaxis - adult |
979 |
952 |
$44K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
196 |
93 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
275 |
161 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,160 |
1,112 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
311 |
297 |
$4K |
| D1351 |
Sealant - per tooth |
230 |
74 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
357 |
336 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
35 |
34 |
$1K |
| D0274 |
Bitewings - four radiographic images |
24 |
24 |
$763.43 |
| D2330 |
|
13 |
12 |
$743.60 |