| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
960 |
932 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,384 |
1,353 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,506 |
1,462 |
$21K |
| D1110 |
Prophylaxis - adult |
506 |
494 |
$17K |
| D0272 |
Bitewings - two radiographic images |
941 |
916 |
$16K |
| D0330 |
Panoramic radiographic image |
306 |
287 |
$13K |
| D0274 |
Bitewings - four radiographic images |
493 |
480 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
136 |
85 |
$10K |
| D1351 |
Sealant - per tooth |
255 |
94 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
176 |
164 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
166 |
159 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
27 |
16 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
93 |
86 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
15 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
29 |
16 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
123 |
113 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
12 |
$954.00 |
| D1206 |
Topical application of fluoride varnish |
48 |
47 |
$615.00 |