| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,490 |
8,374 |
$419K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,505 |
8,383 |
$239K |
| D0120 |
Periodic oral evaluation - established patient |
6,696 |
6,636 |
$187K |
| D1351 |
Sealant - per tooth |
2,948 |
858 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,225 |
1,174 |
$69K |
| D0272 |
Bitewings - two radiographic images |
2,295 |
2,254 |
$65K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
521 |
271 |
$58K |
| D0330 |
Panoramic radiographic image |
739 |
706 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
358 |
202 |
$32K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
135 |
88 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,171 |
1,122 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,021 |
974 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
197 |
97 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
167 |
99 |
$14K |
| D1110 |
Prophylaxis - adult |
180 |
178 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
264 |
255 |
$11K |
| D0274 |
Bitewings - four radiographic images |
213 |
213 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
89 |
63 |
$1K |
| D0240 |
|
35 |
12 |
$0.00 |