| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,893 |
4,570 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
3,196 |
2,607 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
882 |
599 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,817 |
1,407 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,695 |
3,575 |
$51K |
| D0272 |
Bitewings - two radiographic images |
1,974 |
1,635 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,602 |
1,389 |
$30K |
| D0330 |
Panoramic radiographic image |
532 |
445 |
$23K |
| D1206 |
Topical application of fluoride varnish |
915 |
775 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
507 |
405 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
128 |
102 |
$14K |
| D0274 |
Bitewings - four radiographic images |
337 |
273 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
135 |
132 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
77 |
40 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
101 |
12 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
103 |
84 |
$1K |