| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,086 |
15,794 |
$699K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,222 |
2,632 |
$523K |
| D0120 |
Periodic oral evaluation - established patient |
17,637 |
17,335 |
$520K |
| D1206 |
Topical application of fluoride varnish |
20,675 |
20,319 |
$511K |
| D1351 |
Sealant - per tooth |
13,906 |
4,789 |
$475K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,117 |
852 |
$332K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,644 |
1,991 |
$256K |
| D1110 |
Prophylaxis - adult |
3,365 |
3,320 |
$203K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,215 |
712 |
$133K |
| D0330 |
Panoramic radiographic image |
2,745 |
2,693 |
$117K |
| D0272 |
Bitewings - two radiographic images |
5,941 |
5,826 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,676 |
1,648 |
$88K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,513 |
4,130 |
$82K |
| D0274 |
Bitewings - four radiographic images |
3,188 |
3,142 |
$72K |
| D1330 |
|
10,960 |
10,773 |
$67K |
| D1352 |
|
1,196 |
577 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
193 |
191 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
713 |
693 |
$7K |
| D2940 |
|
121 |
69 |
$6K |
| D0240 |
|
312 |
312 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
59 |
59 |
$3K |
| D0270 |
|
40 |
39 |
$360.00 |