| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,699 |
13,512 |
$598K |
| D0120 |
Periodic oral evaluation - established patient |
13,080 |
12,908 |
$387K |
| D1206 |
Topical application of fluoride varnish |
14,624 |
14,431 |
$363K |
| D1351 |
Sealant - per tooth |
9,878 |
2,510 |
$336K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,473 |
1,263 |
$301K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,432 |
716 |
$159K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,394 |
904 |
$132K |
| D0272 |
Bitewings - two radiographic images |
5,564 |
5,482 |
$85K |
| D0330 |
Panoramic radiographic image |
1,646 |
1,622 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,288 |
1,271 |
$69K |
| D9248 |
|
319 |
311 |
$59K |
| D1330 |
|
7,857 |
7,759 |
$49K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,960 |
1,912 |
$36K |
| D1110 |
Prophylaxis - adult |
402 |
400 |
$25K |
| D0274 |
Bitewings - four radiographic images |
778 |
762 |
$18K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
108 |
52 |
$16K |
| D3120 |
|
414 |
243 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,300 |
1,272 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
148 |
146 |
$7K |