| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,303 |
7,247 |
$332K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,661 |
9,309 |
$140K |
| D0120 |
Periodic oral evaluation - established patient |
8,146 |
7,048 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,905 |
978 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,171 |
2,806 |
$74K |
| D1110 |
Prophylaxis - adult |
1,700 |
1,494 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,428 |
908 |
$70K |
| D0272 |
Bitewings - two radiographic images |
4,323 |
3,766 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,236 |
1,828 |
$56K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
391 |
91 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,710 |
2,337 |
$25K |
| D0274 |
Bitewings - four radiographic images |
914 |
828 |
$25K |
| D0330 |
Panoramic radiographic image |
677 |
616 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
461 |
213 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,382 |
1,637 |
$16K |
| D1351 |
Sealant - per tooth |
605 |
194 |
$11K |
| D9420 |
|
237 |
204 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
163 |
65 |
$10K |
| D2140 |
|
209 |
145 |
$9K |