| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,583 |
7,561 |
$344K |
| D0120 |
Periodic oral evaluation - established patient |
7,932 |
7,911 |
$331K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,223 |
1,011 |
$211K |
| D0272 |
Bitewings - two radiographic images |
5,445 |
5,426 |
$155K |
| D1351 |
Sealant - per tooth |
2,784 |
443 |
$114K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,234 |
4,229 |
$111K |
| D1206 |
Topical application of fluoride varnish |
3,450 |
3,433 |
$109K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,323 |
2,176 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
542 |
406 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,206 |
1,203 |
$36K |
| D1110 |
Prophylaxis - adult |
646 |
646 |
$34K |
| D0603 |
|
3,565 |
3,529 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,739 |
1,727 |
$21K |
| D0602 |
|
2,140 |
2,124 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
973 |
969 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
181 |
181 |
$7K |
| D8670 |
Periodic orthodontic treatment visit |
46 |
45 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
15 |
12 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
16 |
13 |
$2K |