| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,591 |
6,887 |
$186K |
| D0120 |
Periodic oral evaluation - established patient |
5,571 |
4,736 |
$115K |
| D0210 |
Intraoral - complete series of radiographic images |
2,154 |
1,718 |
$104K |
| D1206 |
Topical application of fluoride varnish |
5,625 |
4,493 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,168 |
2,253 |
$81K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,329 |
2,106 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,048 |
336 |
$50K |
| D2394 |
|
263 |
121 |
$41K |
| D8670 |
Periodic orthodontic treatment visit |
515 |
422 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,922 |
2,381 |
$38K |
| D1351 |
Sealant - per tooth |
1,859 |
298 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
451 |
218 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
941 |
854 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
3,108 |
2,445 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,813 |
1,507 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
525 |
224 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,028 |
1,861 |
$24K |
| D0274 |
Bitewings - four radiographic images |
944 |
765 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
175 |
84 |
$16K |
| D0330 |
Panoramic radiographic image |
70 |
59 |
$2K |
| D1110 |
Prophylaxis - adult |
55 |
40 |
$470.32 |