| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,171 |
5,107 |
$285K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,021 |
3,969 |
$118K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,543 |
1,002 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,488 |
5,424 |
$88K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
551 |
279 |
$62K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,986 |
1,772 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,041 |
602 |
$58K |
| D1351 |
Sealant - per tooth |
2,518 |
745 |
$55K |
| D0272 |
Bitewings - two radiographic images |
2,227 |
2,197 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,417 |
1,405 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
3,529 |
3,460 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,694 |
2,918 |
$36K |
| D0330 |
Panoramic radiographic image |
685 |
671 |
$35K |
| D0274 |
Bitewings - four radiographic images |
348 |
346 |
$12K |
| D1110 |
Prophylaxis - adult |
200 |
200 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
274 |
267 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
117 |
94 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
37 |
$3K |