| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
18,080 |
16,927 |
$491K |
| D0120 |
Periodic oral evaluation - established patient |
17,098 |
15,961 |
$316K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,984 |
19,607 |
$295K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,702 |
1,533 |
$275K |
| D1999 |
|
12,419 |
11,161 |
$212K |
| D0272 |
Bitewings - two radiographic images |
9,380 |
8,921 |
$160K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,206 |
1,459 |
$159K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,372 |
6,486 |
$151K |
| D0330 |
Panoramic radiographic image |
3,361 |
3,177 |
$150K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,847 |
4,511 |
$123K |
| D1351 |
Sealant - per tooth |
4,619 |
1,267 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,669 |
1,051 |
$85K |
| D0140 |
Limited oral evaluation - problem focused |
2,850 |
2,510 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
928 |
655 |
$55K |
| D1110 |
Prophylaxis - adult |
942 |
896 |
$36K |
| D0240 |
|
2,198 |
1,118 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,610 |
1,475 |
$33K |
| D1354 |
|
948 |
322 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,635 |
1,517 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
587 |
552 |
$13K |
| D0274 |
Bitewings - four radiographic images |
449 |
434 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
951 |
360 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
25 |
$1K |
| D2332 |
|
13 |
12 |
$1K |