| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,504 |
7,114 |
$354K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,047 |
6,631 |
$173K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,370 |
1,581 |
$158K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,119 |
8,662 |
$136K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,293 |
2,096 |
$86K |
| D0330 |
Panoramic radiographic image |
1,902 |
1,820 |
$85K |
| D1110 |
Prophylaxis - adult |
1,720 |
1,643 |
$82K |
| D0272 |
Bitewings - two radiographic images |
4,021 |
3,791 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,227 |
904 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,411 |
2,359 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,017 |
609 |
$58K |
| D1351 |
Sealant - per tooth |
2,938 |
929 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,345 |
1,295 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
455 |
358 |
$38K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
189 |
137 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,637 |
1,558 |
$16K |
| D9110 |
|
451 |
409 |
$11K |
| D2332 |
|
105 |
71 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,103 |
911 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
138 |
130 |
$6K |
| D9248 |
|
52 |
43 |
$5K |