| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
9,815 |
6,096 |
$643K |
| D1120 |
Prophylaxis - child |
12,090 |
11,777 |
$496K |
| D0120 |
Periodic oral evaluation - established patient |
11,851 |
11,616 |
$330K |
| D1206 |
Topical application of fluoride varnish |
12,004 |
11,685 |
$310K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
629 |
527 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
207 |
142 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
207 |
155 |
$8K |
| D0272 |
Bitewings - two radiographic images |
534 |
527 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
13 |
$877.34 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$286.80 |
| D0603 |
|
994 |
978 |
$0.00 |
| D0601 |
|
3,273 |
3,215 |
$0.00 |
| D0602 |
|
2,756 |
2,716 |
$0.00 |