| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,705 |
7,454 |
$270K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,364 |
1,227 |
$208K |
| D0120 |
Periodic oral evaluation - established patient |
6,855 |
6,639 |
$189K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
846 |
378 |
$114K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,716 |
5,563 |
$113K |
| D1110 |
Prophylaxis - adult |
2,264 |
2,201 |
$109K |
| D1351 |
Sealant - per tooth |
3,784 |
1,111 |
$103K |
| D0272 |
Bitewings - two radiographic images |
4,807 |
4,674 |
$99K |
| D1206 |
Topical application of fluoride varnish |
3,894 |
3,767 |
$93K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,348 |
2,110 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,863 |
1,817 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,190 |
737 |
$83K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,278 |
1,254 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
2,927 |
2,734 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
577 |
313 |
$35K |
| D0330 |
Panoramic radiographic image |
599 |
562 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,782 |
1,426 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
844 |
777 |
$11K |
| D9248 |
|
52 |
48 |
$6K |
| D9920 |
|
155 |
117 |
$701.00 |
| D1999 |
|
430 |
360 |
$0.00 |