| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,560 |
5,359 |
$280K |
| D0120 |
Periodic oral evaluation - established patient |
4,106 |
3,939 |
$78K |
| D1206 |
Topical application of fluoride varnish |
3,996 |
3,934 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,161 |
2,103 |
$59K |
| D0272 |
Bitewings - two radiographic images |
3,613 |
3,459 |
$51K |
| D0330 |
Panoramic radiographic image |
1,037 |
1,017 |
$41K |
| D1351 |
Sealant - per tooth |
1,961 |
526 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,185 |
2,021 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,816 |
1,091 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
389 |
260 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,865 |
1,811 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
575 |
553 |
$18K |
| D1110 |
Prophylaxis - adult |
322 |
319 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
494 |
473 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
219 |
156 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
62 |
28 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
37 |
$2K |
| D0274 |
Bitewings - four radiographic images |
71 |
71 |
$2K |