| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,830 |
7,779 |
$205K |
| D1351 |
Sealant - per tooth |
4,779 |
1,715 |
$190K |
| D1120 |
Prophylaxis - child |
5,609 |
5,573 |
$172K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,926 |
1,650 |
$154K |
| D0272 |
Bitewings - two radiographic images |
7,075 |
7,022 |
$137K |
| D1110 |
Prophylaxis - adult |
3,117 |
3,103 |
$132K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,657 |
6,607 |
$127K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,208 |
3,139 |
$121K |
| D0603 |
|
7,334 |
7,316 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,094 |
970 |
$68K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
237 |
226 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
547 |
436 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,690 |
1,679 |
$38K |
| D0330 |
Panoramic radiographic image |
522 |
518 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
548 |
545 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
228 |
228 |
$6K |
| D0240 |
|
203 |
198 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
402 |
394 |
$4K |
| D1354 |
|
338 |
145 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
81 |
80 |
$2K |
| D1330 |
|
360 |
360 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
18 |
$2K |
| D0602 |
|
132 |
132 |
$1K |
| D2330 |
|
12 |
12 |
$1K |