| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,434 |
8,058 |
$335K |
| D0120 |
Periodic oral evaluation - established patient |
7,732 |
7,369 |
$238K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,791 |
993 |
$174K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,640 |
5,401 |
$140K |
| D8670 |
Periodic orthodontic treatment visit |
1,279 |
1,254 |
$95K |
| D0272 |
Bitewings - two radiographic images |
2,097 |
2,023 |
$61K |
| D1206 |
Topical application of fluoride varnish |
2,106 |
2,030 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
842 |
748 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
434 |
225 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
451 |
279 |
$35K |
| D1351 |
Sealant - per tooth |
720 |
189 |
$25K |
| D0330 |
Panoramic radiographic image |
299 |
292 |
$21K |
| D0274 |
Bitewings - four radiographic images |
361 |
342 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
182 |
178 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
77 |
71 |
$3K |
| D8660 |
|
31 |
29 |
$975.27 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$204.82 |