| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,367 |
8,106 |
$354K |
| D1206 |
Topical application of fluoride varnish |
9,243 |
8,962 |
$317K |
| D0120 |
Periodic oral evaluation - established patient |
8,319 |
8,071 |
$186K |
| D0272 |
Bitewings - two radiographic images |
6,099 |
5,894 |
$102K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,467 |
814 |
$67K |
| D9248 |
|
783 |
696 |
$65K |
| D1351 |
Sealant - per tooth |
2,684 |
841 |
$51K |
| D0330 |
Panoramic radiographic image |
1,013 |
976 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,012 |
2,733 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
838 |
833 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
683 |
362 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
616 |
420 |
$21K |
| D1110 |
Prophylaxis - adult |
403 |
389 |
$17K |
| D0274 |
Bitewings - four radiographic images |
646 |
627 |
$15K |
| D0603 |
|
4,771 |
4,622 |
$14K |
| D0999 |
Unspecified diagnostic procedure, by report |
392 |
392 |
$12K |
| D9999 |
Unspecified adjunctive procedure, by report |
545 |
545 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
154 |
51 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
301 |
294 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
806 |
775 |
$8K |
| D1353 |
|
360 |
165 |
$4K |
| D0240 |
|
203 |
139 |
$2K |
| D1999 |
|
1,240 |
1,133 |
$2K |
| D9215 |
|
626 |
563 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
190 |
153 |
$977.95 |
| D1208 |
Topical application of fluoride, excluding varnish |
109 |
96 |
$860.16 |