| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,547 |
4,526 |
$141K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,351 |
2,328 |
$107K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
861 |
636 |
$65K |
| D7140 |
Extraction, erupted tooth or exposed root |
681 |
439 |
$36K |
| D1206 |
Topical application of fluoride varnish |
5,517 |
5,491 |
$30K |
| D1110 |
Prophylaxis - adult |
788 |
787 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
2,580 |
2,577 |
$21K |
| D1351 |
Sealant - per tooth |
2,977 |
725 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
81 |
69 |
$14K |
| D0330 |
Panoramic radiographic image |
148 |
148 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
217 |
170 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,359 |
1,282 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,353 |
3,456 |
$8K |
| D0272 |
Bitewings - two radiographic images |
2,557 |
2,539 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
161 |
160 |
$7K |
| D1330 |
|
2,782 |
2,779 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
4,021 |
3,933 |
$6K |
| D0274 |
Bitewings - four radiographic images |
643 |
641 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
158 |
157 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
57 |
57 |
$1K |