| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,867 |
10,266 |
$457K |
| D1206 |
Topical application of fluoride varnish |
11,815 |
11,143 |
$408K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,047 |
1,166 |
$218K |
| D0120 |
Periodic oral evaluation - established patient |
8,987 |
8,598 |
$184K |
| D1351 |
Sealant - per tooth |
4,718 |
1,344 |
$155K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,919 |
1,037 |
$147K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,686 |
750 |
$142K |
| D0272 |
Bitewings - two radiographic images |
3,428 |
3,211 |
$82K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,457 |
2,202 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,893 |
1,645 |
$66K |
| D1110 |
Prophylaxis - adult |
983 |
920 |
$60K |
| D1310 |
|
1,323 |
1,057 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,264 |
1,192 |
$43K |
| D1330 |
|
1,315 |
1,055 |
$39K |
| D0240 |
|
886 |
852 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
889 |
824 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,474 |
1,401 |
$22K |
| D8670 |
Periodic orthodontic treatment visit |
158 |
77 |
$13K |
| D8660 |
|
52 |
26 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
52 |
13 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
179 |
165 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
102 |
102 |
$1K |
| D9430 |
|
26 |
13 |
$1K |
| D9450 |
|
24 |
12 |
$1K |
| D9920 |
|
40 |
40 |
$975.00 |
| D3120 |
|
21 |
12 |
$798.00 |