| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,140 |
2,965 |
$82K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,737 |
1,537 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,512 |
1,422 |
$65K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
565 |
386 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
711 |
491 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,227 |
3,031 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
1,890 |
1,824 |
$49K |
| D0240 |
|
2,203 |
1,063 |
$34K |
| D1351 |
Sealant - per tooth |
1,224 |
400 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,182 |
1,105 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,204 |
1,097 |
$17K |
| D1110 |
Prophylaxis - adult |
257 |
243 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
484 |
296 |
$6K |
| D1206 |
Topical application of fluoride varnish |
353 |
323 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
48 |
31 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
123 |
97 |
$2K |
| D0170 |
|
74 |
70 |
$2K |
| D0274 |
Bitewings - four radiographic images |
63 |
60 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
52 |
49 |
$2K |
| D1310 |
|
21 |
21 |
$0.00 |
| D1330 |
|
22 |
22 |
$0.00 |