| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,067 |
2,948 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
821 |
359 |
$58K |
| D1206 |
Topical application of fluoride varnish |
3,349 |
3,221 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
2,432 |
2,361 |
$53K |
| D0272 |
Bitewings - two radiographic images |
1,985 |
1,896 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
710 |
663 |
$25K |
| D0240 |
|
1,244 |
857 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,675 |
1,556 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,701 |
1,421 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
128 |
39 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
492 |
438 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
133 |
70 |
$8K |
| D0274 |
Bitewings - four radiographic images |
354 |
334 |
$8K |
| D0330 |
Panoramic radiographic image |
307 |
257 |
$8K |
| D1110 |
Prophylaxis - adult |
181 |
166 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
94 |
91 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
50 |
44 |
$838.64 |
| D0145 |
Oral evaluation for a patient under three years of age |
29 |
27 |
$593.16 |
| D1330 |
|
560 |
537 |
$52.40 |