| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,284 |
7,143 |
$315K |
| D0120 |
Periodic oral evaluation - established patient |
8,456 |
8,292 |
$246K |
| D1206 |
Topical application of fluoride varnish |
9,822 |
9,632 |
$238K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,083 |
771 |
$131K |
| D1110 |
Prophylaxis - adult |
2,164 |
2,118 |
$128K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,253 |
852 |
$119K |
| D1351 |
Sealant - per tooth |
2,304 |
834 |
$78K |
| D0330 |
Panoramic radiographic image |
1,384 |
1,352 |
$58K |
| D0272 |
Bitewings - two radiographic images |
2,783 |
2,731 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,262 |
1,997 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
659 |
637 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,257 |
1,229 |
$28K |
| D1330 |
|
4,424 |
4,351 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
411 |
385 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
59 |
37 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
176 |
169 |
$2K |