| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,835 |
7,764 |
$427K |
| D0120 |
Periodic oral evaluation - established patient |
9,509 |
9,404 |
$392K |
| D1206 |
Topical application of fluoride varnish |
8,855 |
8,780 |
$250K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,110 |
711 |
$243K |
| D0272 |
Bitewings - two radiographic images |
5,091 |
5,043 |
$186K |
| D1110 |
Prophylaxis - adult |
2,559 |
2,542 |
$185K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,704 |
1,620 |
$124K |
| D1351 |
Sealant - per tooth |
2,154 |
600 |
$94K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
450 |
310 |
$78K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
412 |
249 |
$65K |
| D0330 |
Panoramic radiographic image |
731 |
726 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
189 |
127 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
1,841 |
1,788 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
417 |
415 |
$29K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
79 |
52 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
101 |
65 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
661 |
371 |
$14K |
| D0240 |
|
430 |
384 |
$13K |
| D2140 |
|
17 |
12 |
$2K |
| D0603 |
|
10,328 |
10,232 |
$0.00 |
| D0602 |
|
93 |
88 |
$0.00 |