| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,515 |
13,536 |
$410K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,794 |
2,245 |
$320K |
| D0120 |
Periodic oral evaluation - established patient |
15,841 |
14,927 |
$311K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,878 |
16,670 |
$260K |
| D0272 |
Bitewings - two radiographic images |
12,878 |
11,994 |
$194K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,087 |
6,348 |
$172K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,630 |
1,168 |
$117K |
| D0330 |
Panoramic radiographic image |
1,237 |
1,214 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
5,974 |
5,449 |
$65K |
| D1110 |
Prophylaxis - adult |
1,389 |
1,345 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
905 |
515 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,221 |
2,062 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,714 |
1,610 |
$37K |
| D1354 |
|
690 |
426 |
$30K |
| D1351 |
Sealant - per tooth |
1,217 |
467 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
297 |
292 |
$11K |
| D1999 |
|
255 |
241 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
65 |
63 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
19 |
19 |
$448.80 |