| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,959 |
6,817 |
$189K |
| D1351 |
Sealant - per tooth |
8,895 |
1,928 |
$160K |
| D0120 |
Periodic oral evaluation - established patient |
7,386 |
7,180 |
$149K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,251 |
9,953 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,937 |
1,204 |
$131K |
| D7240 |
Removal of impacted tooth - completely bony |
713 |
222 |
$131K |
| D0274 |
Bitewings - four radiographic images |
5,228 |
5,070 |
$120K |
| D1110 |
Prophylaxis - adult |
2,765 |
2,621 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,731 |
1,139 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,714 |
2,609 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
6,408 |
6,174 |
$57K |
| D0272 |
Bitewings - two radiographic images |
3,369 |
3,276 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,662 |
5,327 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
761 |
712 |
$16K |
| D0330 |
Panoramic radiographic image |
1,100 |
1,066 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
148 |
105 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
201 |
199 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
100 |
100 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
329 |
305 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
89 |
70 |
$6K |
| D8660 |
|
12 |
12 |
$1K |
| D0270 |
|
163 |
154 |
$1K |
| D1999 |
|
72 |
60 |
$0.00 |
| D0603 |
|
4,115 |
3,862 |
$0.00 |
| D0602 |
|
850 |
846 |
$0.00 |
| D0601 |
|
96 |
96 |
$0.00 |