| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2335 |
|
1,320 |
977 |
$480K |
| D1120 |
Prophylaxis - child |
9,899 |
9,453 |
$408K |
| D2332 |
|
1,310 |
922 |
$373K |
| D1351 |
Sealant - per tooth |
3,654 |
2,273 |
$317K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,591 |
1,259 |
$287K |
| D1206 |
Topical application of fluoride varnish |
9,347 |
8,929 |
$244K |
| D0120 |
Periodic oral evaluation - established patient |
8,232 |
7,891 |
$233K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,302 |
1,011 |
$88K |
| D2394 |
|
550 |
468 |
$82K |
| D0274 |
Bitewings - four radiographic images |
3,504 |
3,394 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
9,398 |
8,880 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
879 |
808 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,223 |
2,081 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
645 |
551 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,629 |
8,108 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
1,656 |
1,452 |
$30K |
| D9110 |
|
534 |
513 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
541 |
469 |
$29K |
| D0330 |
Panoramic radiographic image |
1,091 |
1,021 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,482 |
1,413 |
$15K |
| D8670 |
Periodic orthodontic treatment visit |
39 |
39 |
$8K |
| D1520 |
|
45 |
43 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
222 |
214 |
$4K |
| D9310 |
|
139 |
139 |
$2K |