| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,253 |
6,811 |
$193K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,738 |
1,191 |
$180K |
| D1351 |
Sealant - per tooth |
7,068 |
2,091 |
$179K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,932 |
1,306 |
$155K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,473 |
3,423 |
$143K |
| D1206 |
Topical application of fluoride varnish |
4,030 |
3,960 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
3,966 |
3,565 |
$87K |
| D0330 |
Panoramic radiographic image |
1,567 |
1,502 |
$65K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,650 |
2,263 |
$62K |
| D0274 |
Bitewings - four radiographic images |
2,081 |
2,028 |
$52K |
| D0272 |
Bitewings - two radiographic images |
3,077 |
2,863 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,212 |
2,914 |
$46K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
308 |
195 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
3,543 |
3,262 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,633 |
2,337 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
314 |
314 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
154 |
102 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
195 |
187 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
29 |
$5K |
| D2330 |
|
20 |
13 |
$1K |
| D1110 |
Prophylaxis - adult |
37 |
37 |
$1K |
| D1999 |
|
1,344 |
1,256 |
$0.00 |