| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,547 |
7,298 |
$228K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,088 |
10,556 |
$192K |
| D0120 |
Periodic oral evaluation - established patient |
8,414 |
8,142 |
$183K |
| D0274 |
Bitewings - four radiographic images |
4,800 |
4,635 |
$142K |
| D1110 |
Prophylaxis - adult |
2,919 |
2,826 |
$122K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,308 |
793 |
$93K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,753 |
2,522 |
$76K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
468 |
126 |
$56K |
| D0330 |
Panoramic radiographic image |
949 |
914 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,087 |
1,046 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
281 |
199 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
422 |
406 |
$13K |
| D7961 |
|
95 |
91 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
131 |
64 |
$11K |
| D7962 |
|
77 |
73 |
$10K |
| D1351 |
Sealant - per tooth |
299 |
77 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
240 |
230 |
$3K |
| D0272 |
Bitewings - two radiographic images |
51 |
48 |
$958.89 |