| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
17,905 |
17,744 |
$914K |
| D0120 |
Periodic oral evaluation - established patient |
18,360 |
18,206 |
$539K |
| D1206 |
Topical application of fluoride varnish |
19,904 |
19,731 |
$523K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,896 |
1,645 |
$306K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,833 |
1,294 |
$255K |
| D0272 |
Bitewings - two radiographic images |
6,918 |
6,826 |
$203K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,056 |
264 |
$179K |
| D1110 |
Prophylaxis - adult |
2,400 |
2,374 |
$165K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,753 |
1,046 |
$150K |
| D1351 |
Sealant - per tooth |
3,789 |
1,206 |
$148K |
| D9110 |
|
1,501 |
1,444 |
$104K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,133 |
765 |
$97K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,150 |
3,733 |
$82K |
| D0274 |
Bitewings - four radiographic images |
1,800 |
1,789 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,353 |
1,339 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
3,044 |
2,926 |
$57K |
| D0330 |
Panoramic radiographic image |
587 |
579 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,777 |
1,595 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
322 |
308 |
$15K |
| D2335 |
|
25 |
12 |
$3K |
| D7111 |
|
41 |
16 |
$3K |
| D2160 |
|
24 |
18 |
$2K |
| D1999 |
|
91 |
88 |
$0.00 |