| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,054 |
7,896 |
$345K |
| D0120 |
Periodic oral evaluation - established patient |
7,914 |
7,721 |
$255K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,003 |
7,801 |
$215K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
971 |
526 |
$97K |
| D0272 |
Bitewings - two radiographic images |
2,644 |
2,599 |
$79K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,162 |
1,070 |
$62K |
| D1351 |
Sealant - per tooth |
1,096 |
261 |
$41K |
| D0274 |
Bitewings - four radiographic images |
553 |
536 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
173 |
117 |
$14K |
| D0330 |
Panoramic radiographic image |
68 |
67 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
298 |
291 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
25 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
48 |
43 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
66 |
52 |
$1K |