| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,636 |
9,540 |
$402K |
| D1351 |
Sealant - per tooth |
3,184 |
2,373 |
$346K |
| D0120 |
Periodic oral evaluation - established patient |
10,324 |
10,208 |
$294K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,978 |
8,906 |
$239K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,457 |
1,339 |
$131K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,241 |
1,133 |
$111K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
697 |
630 |
$104K |
| D0274 |
Bitewings - four radiographic images |
3,678 |
3,649 |
$72K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,020 |
970 |
$65K |
| D9110 |
|
852 |
828 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
6,393 |
6,268 |
$42K |
| D2332 |
|
257 |
221 |
$39K |
| D1110 |
Prophylaxis - adult |
657 |
656 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,202 |
1,191 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,551 |
5,480 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
433 |
394 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
177 |
154 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,489 |
1,453 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
114 |
104 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
790 |
769 |
$15K |
| D4341 |
|
46 |
25 |
$9K |
| D1206 |
Topical application of fluoride varnish |
288 |
267 |
$7K |
| D2330 |
|
33 |
31 |
$2K |
| D1510 |
|
16 |
16 |
$2K |
| D2331 |
|
13 |
13 |
$834.88 |
| D0270 |
|
57 |
53 |
$313.60 |