| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,237 |
7,130 |
$313K |
| D1206 |
Topical application of fluoride varnish |
6,997 |
6,887 |
$191K |
| D0120 |
Periodic oral evaluation - established patient |
5,684 |
5,600 |
$189K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,573 |
1,033 |
$156K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,262 |
2,120 |
$124K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,341 |
823 |
$111K |
| D7140 |
Extraction, erupted tooth or exposed root |
801 |
445 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,367 |
1,345 |
$83K |
| D1354 |
|
4,739 |
1,603 |
$66K |
| D0272 |
Bitewings - two radiographic images |
2,101 |
2,056 |
$62K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
332 |
150 |
$62K |
| D1351 |
Sealant - per tooth |
1,392 |
575 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
1,723 |
1,676 |
$31K |
| D0330 |
Panoramic radiographic image |
248 |
244 |
$19K |
| D0274 |
Bitewings - four radiographic images |
409 |
405 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
209 |
196 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
403 |
250 |
$7K |