| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,693 |
6,446 |
$233K |
| D0120 |
Periodic oral evaluation - established patient |
6,793 |
6,549 |
$150K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,762 |
1,068 |
$116K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,986 |
4,820 |
$105K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
658 |
288 |
$93K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,229 |
2,065 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
748 |
392 |
$60K |
| D0272 |
Bitewings - two radiographic images |
2,517 |
2,413 |
$58K |
| D1110 |
Prophylaxis - adult |
1,137 |
1,109 |
$54K |
| D1206 |
Topical application of fluoride varnish |
2,497 |
2,383 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,300 |
1,237 |
$46K |
| D1351 |
Sealant - per tooth |
1,121 |
339 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
362 |
219 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
538 |
496 |
$19K |
| D0330 |
Panoramic radiographic image |
136 |
133 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
490 |
457 |
$6K |
| D0274 |
Bitewings - four radiographic images |
54 |
54 |
$2K |
| D1999 |
|
124 |
108 |
$36.00 |