| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,324 |
3,978 |
$172K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,241 |
1,710 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
4,101 |
3,786 |
$111K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,056 |
3,735 |
$102K |
| D1351 |
Sealant - per tooth |
872 |
620 |
$71K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,407 |
1,173 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
479 |
401 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
817 |
660 |
$36K |
| D8670 |
Periodic orthodontic treatment visit |
188 |
166 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,474 |
1,322 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,852 |
1,698 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
308 |
253 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,645 |
1,520 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
755 |
592 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,928 |
1,795 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
474 |
439 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,319 |
1,242 |
$8K |
| D0330 |
Panoramic radiographic image |
308 |
267 |
$6K |
| D1110 |
Prophylaxis - adult |
176 |
159 |
$5K |
| D1354 |
|
90 |
69 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
44 |
26 |
$3K |
| D9310 |
|
196 |
193 |
$3K |
| D0270 |
|
24 |
24 |
$134.40 |