| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,301 |
6,149 |
$167K |
| D0120 |
Periodic oral evaluation - established patient |
5,037 |
4,939 |
$131K |
| D1206 |
Topical application of fluoride varnish |
6,659 |
6,491 |
$106K |
| D1351 |
Sealant - per tooth |
2,077 |
605 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,271 |
1,222 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,066 |
1,001 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
414 |
299 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
293 |
223 |
$39K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
249 |
77 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
820 |
761 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,637 |
1,585 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,903 |
715 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
317 |
171 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,220 |
1,171 |
$18K |
| D1110 |
Prophylaxis - adult |
395 |
384 |
$15K |
| D0240 |
|
883 |
441 |
$14K |
| D0330 |
Panoramic radiographic image |
139 |
133 |
$8K |
| D0274 |
Bitewings - four radiographic images |
42 |
42 |
$1K |