| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,044 |
4,927 |
$225K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,465 |
1,035 |
$198K |
| D0120 |
Periodic oral evaluation - established patient |
4,738 |
4,655 |
$192K |
| D1206 |
Topical application of fluoride varnish |
4,606 |
4,501 |
$118K |
| D0272 |
Bitewings - two radiographic images |
3,171 |
3,053 |
$84K |
| D9420 |
|
251 |
243 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,360 |
1,169 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
481 |
290 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
1,964 |
1,870 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
445 |
430 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
443 |
426 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,322 |
1,226 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
162 |
86 |
$14K |
| D1351 |
Sealant - per tooth |
344 |
108 |
$12K |
| D0601 |
|
1,681 |
1,653 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
65 |
25 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
465 |
462 |
$9K |
| D1110 |
Prophylaxis - adult |
118 |
118 |
$8K |
| D0603 |
|
1,102 |
1,073 |
$7K |
| D0330 |
Panoramic radiographic image |
54 |
53 |
$3K |
| D0602 |
|
364 |
358 |
$2K |