| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,071 |
3,926 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
4,797 |
4,639 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,821 |
5,634 |
$84K |
| D1999 |
|
3,492 |
3,315 |
$66K |
| D0272 |
Bitewings - two radiographic images |
2,253 |
2,165 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,681 |
1,524 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,835 |
2,672 |
$30K |
| D0330 |
Panoramic radiographic image |
629 |
608 |
$30K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
333 |
80 |
$26K |
| D1110 |
Prophylaxis - adult |
627 |
601 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,958 |
1,779 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
287 |
187 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
181 |
111 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
280 |
262 |
$7K |
| D0274 |
Bitewings - four radiographic images |
313 |
299 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
232 |
226 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
25 |
$2K |