| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,995 |
11,843 |
$522K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,033 |
1,890 |
$495K |
| D1351 |
Sealant - per tooth |
11,159 |
1,894 |
$368K |
| D0120 |
Periodic oral evaluation - established patient |
12,027 |
11,888 |
$360K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,624 |
9,487 |
$219K |
| D1110 |
Prophylaxis - adult |
2,553 |
2,521 |
$153K |
| D1206 |
Topical application of fluoride varnish |
5,255 |
5,200 |
$130K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,276 |
2,246 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,003 |
607 |
$96K |
| D0330 |
Panoramic radiographic image |
2,094 |
2,072 |
$90K |
| D0272 |
Bitewings - two radiographic images |
3,891 |
3,828 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
464 |
332 |
$51K |
| D1330 |
|
8,231 |
8,107 |
$49K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
301 |
171 |
$47K |
| D0274 |
Bitewings - four radiographic images |
2,046 |
2,016 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
943 |
924 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,030 |
900 |
$19K |
| D9248 |
|
41 |
39 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
816 |
798 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
53 |
52 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
14 |
$114.00 |