| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,976 |
2,959 |
$175K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,289 |
1,079 |
$160K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,363 |
2,346 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,117 |
628 |
$59K |
| D1206 |
Topical application of fluoride varnish |
2,321 |
2,305 |
$40K |
| D0330 |
Panoramic radiographic image |
582 |
581 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
453 |
293 |
$38K |
| D1110 |
Prophylaxis - adult |
634 |
630 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,328 |
1,324 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,384 |
1,379 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
847 |
778 |
$28K |
| D1351 |
Sealant - per tooth |
856 |
297 |
$20K |
| D0274 |
Bitewings - four radiographic images |
443 |
438 |
$16K |
| D2332 |
|
69 |
24 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
120 |
119 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
28 |
$4K |
| D2394 |
|
33 |
25 |
$3K |
| D2331 |
|
26 |
14 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
113 |
112 |
$1K |