| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,698 |
3,663 |
$219K |
| D0120 |
Periodic oral evaluation - established patient |
3,177 |
3,148 |
$82K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
800 |
431 |
$57K |
| D1206 |
Topical application of fluoride varnish |
2,828 |
2,808 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,111 |
1,102 |
$36K |
| D0330 |
Panoramic radiographic image |
661 |
655 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,342 |
1,327 |
$29K |
| D1110 |
Prophylaxis - adult |
499 |
493 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
564 |
552 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,248 |
1,231 |
$18K |
| D1351 |
Sealant - per tooth |
763 |
213 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,102 |
1,058 |
$14K |
| D0274 |
Bitewings - four radiographic images |
374 |
369 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,214 |
498 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
97 |
58 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
157 |
107 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
213 |
207 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
86 |
55 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
74 |
55 |
$4K |