| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,262 |
5,166 |
$184K |
| D1120 |
Prophylaxis - child |
3,426 |
3,370 |
$153K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,244 |
738 |
$139K |
| D1110 |
Prophylaxis - adult |
2,166 |
2,126 |
$129K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,982 |
3,905 |
$108K |
| D1351 |
Sealant - per tooth |
2,478 |
736 |
$89K |
| D0210 |
Intraoral - complete series of radiographic images |
736 |
723 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
798 |
516 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
770 |
510 |
$74K |
| D0272 |
Bitewings - two radiographic images |
1,514 |
1,495 |
$48K |
| D1206 |
Topical application of fluoride varnish |
1,703 |
1,685 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,117 |
1,096 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
979 |
899 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
743 |
716 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
510 |
510 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
971 |
940 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
416 |
416 |
$16K |
| D0330 |
Panoramic radiographic image |
81 |
81 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
22 |
14 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
270 |
217 |
$4K |