| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,071 |
6,745 |
$189K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,623 |
1,055 |
$172K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,610 |
3,268 |
$159K |
| D0120 |
Periodic oral evaluation - established patient |
5,639 |
5,388 |
$144K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,437 |
7,096 |
$122K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,505 |
962 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,820 |
1,761 |
$82K |
| D1351 |
Sealant - per tooth |
1,987 |
551 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
2,986 |
2,688 |
$42K |
| D0272 |
Bitewings - two radiographic images |
2,356 |
2,230 |
$42K |
| D0240 |
|
2,306 |
1,156 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
598 |
420 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
834 |
803 |
$31K |
| D1110 |
Prophylaxis - adult |
821 |
784 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,997 |
1,292 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
48 |
39 |
$7K |
| D1206 |
Topical application of fluoride varnish |
340 |
321 |
$5K |
| D0274 |
Bitewings - four radiographic images |
139 |
136 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
150 |
101 |
$3K |
| D0170 |
|
86 |
83 |
$2K |
| D0330 |
Panoramic radiographic image |
14 |
13 |
$780.60 |
| D1354 |
|
48 |
15 |
$335.50 |
| D1330 |
|
52 |
52 |
$0.00 |
| D1310 |
|
37 |
37 |
$0.00 |