| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
17,447 |
17,238 |
$770K |
| D0120 |
Periodic oral evaluation - established patient |
16,708 |
16,509 |
$497K |
| D1206 |
Topical application of fluoride varnish |
19,126 |
18,898 |
$475K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,009 |
1,061 |
$253K |
| D9248 |
|
1,021 |
1,009 |
$189K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,432 |
818 |
$169K |
| D1110 |
Prophylaxis - adult |
2,038 |
2,010 |
$121K |
| D0272 |
Bitewings - two radiographic images |
7,672 |
7,576 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,208 |
2,178 |
$116K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
630 |
326 |
$108K |
| D0330 |
Panoramic radiographic image |
2,029 |
2,001 |
$87K |
| D0274 |
Bitewings - four radiographic images |
2,089 |
2,066 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,822 |
1,759 |
$34K |
| D1351 |
Sealant - per tooth |
824 |
257 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
296 |
214 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
577 |
567 |
$26K |
| D0240 |
|
1,503 |
1,486 |
$22K |
| D9310 |
|
448 |
445 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,375 |
1,358 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
450 |
446 |
$7K |
| D3120 |
|
150 |
107 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
89 |
86 |
$4K |