| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,284 |
7,213 |
$243K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,487 |
1,479 |
$186K |
| D1206 |
Topical application of fluoride varnish |
8,483 |
8,412 |
$183K |
| D0120 |
Periodic oral evaluation - established patient |
5,352 |
5,321 |
$133K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,281 |
3,225 |
$95K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,178 |
2,908 |
$93K |
| D1110 |
Prophylaxis - adult |
1,708 |
1,699 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,113 |
813 |
$69K |
| D0272 |
Bitewings - two radiographic images |
2,820 |
2,802 |
$50K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
330 |
176 |
$35K |
| D0330 |
Panoramic radiographic image |
991 |
983 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,188 |
2,075 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
426 |
270 |
$24K |
| D0274 |
Bitewings - four radiographic images |
853 |
848 |
$23K |
| D1351 |
Sealant - per tooth |
795 |
241 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
996 |
986 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
910 |
724 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
88 |
66 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
276 |
275 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
55 |
44 |
$2K |