| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,847 |
7,658 |
$204K |
| D1120 |
Prophylaxis - child |
10,782 |
6,077 |
$170K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,554 |
934 |
$155K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,368 |
2,550 |
$128K |
| D1206 |
Topical application of fluoride varnish |
9,087 |
6,945 |
$115K |
| D1110 |
Prophylaxis - adult |
4,099 |
2,246 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,833 |
749 |
$86K |
| D1351 |
Sealant - per tooth |
5,137 |
861 |
$83K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
773 |
148 |
$47K |
| D0272 |
Bitewings - two radiographic images |
4,031 |
2,232 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,161 |
372 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,986 |
1,105 |
$35K |
| D0330 |
Panoramic radiographic image |
1,095 |
625 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,125 |
627 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,821 |
1,352 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
887 |
453 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,566 |
869 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
771 |
227 |
$7K |
| D0240 |
|
584 |
162 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
34 |
31 |
$1K |
| D1354 |
|
28 |
12 |
$203.50 |