| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,406 |
6,841 |
$303K |
| D1206 |
Topical application of fluoride varnish |
7,927 |
7,339 |
$274K |
| D0120 |
Periodic oral evaluation - established patient |
6,377 |
5,884 |
$127K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
893 |
516 |
$90K |
| D1351 |
Sealant - per tooth |
2,646 |
749 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,007 |
540 |
$74K |
| D7140 |
Extraction, erupted tooth or exposed root |
884 |
401 |
$73K |
| D0272 |
Bitewings - two radiographic images |
2,481 |
2,295 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,382 |
1,224 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,019 |
952 |
$35K |
| D1110 |
Prophylaxis - adult |
548 |
490 |
$31K |
| D1310 |
|
869 |
700 |
$30K |
| D1330 |
|
876 |
702 |
$26K |
| D0274 |
Bitewings - four radiographic images |
786 |
726 |
$26K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
150 |
27 |
$20K |
| D0240 |
|
409 |
397 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
800 |
712 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
243 |
216 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
179 |
141 |
$4K |
| D3120 |
|
22 |
12 |
$836.00 |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$612.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
13 |
$446.25 |