| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,014 |
2,835 |
$99K |
| D1120 |
Prophylaxis - child |
3,353 |
3,139 |
$87K |
| D1206 |
Topical application of fluoride varnish |
3,105 |
2,904 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
961 |
587 |
$73K |
| D1351 |
Sealant - per tooth |
1,945 |
451 |
$50K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
218 |
95 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,037 |
926 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
341 |
200 |
$21K |
| D9999 |
Unspecified adjunctive procedure, by report |
519 |
478 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
287 |
254 |
$13K |
| D0330 |
Panoramic radiographic image |
351 |
326 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,307 |
1,216 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
142 |
73 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
212 |
194 |
$5K |
| D0240 |
|
230 |
117 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
242 |
223 |
$2K |