| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,320 |
7,292 |
$252K |
| D0120 |
Periodic oral evaluation - established patient |
9,302 |
9,270 |
$231K |
| D1206 |
Topical application of fluoride varnish |
9,767 |
9,732 |
$211K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,463 |
1,364 |
$152K |
| D1110 |
Prophylaxis - adult |
2,642 |
2,635 |
$117K |
| D1351 |
Sealant - per tooth |
2,953 |
875 |
$91K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,132 |
742 |
$84K |
| D0272 |
Bitewings - two radiographic images |
4,351 |
4,334 |
$79K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,097 |
2,049 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
1,851 |
1,832 |
$23K |
| D0330 |
Panoramic radiographic image |
205 |
203 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
222 |
221 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
426 |
373 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
60 |
44 |
$4K |
| D9248 |
|
33 |
33 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
89 |
89 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
53 |
53 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
48 |
48 |
$963.50 |