| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,707 |
12,409 |
$466K |
| D0120 |
Periodic oral evaluation - established patient |
15,153 |
14,846 |
$456K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,742 |
2,840 |
$419K |
| D1110 |
Prophylaxis - adult |
7,330 |
7,187 |
$365K |
| D1206 |
Topical application of fluoride varnish |
17,081 |
16,652 |
$313K |
| D0140 |
Limited oral evaluation - problem focused |
9,496 |
9,136 |
$307K |
| D0330 |
Panoramic radiographic image |
4,639 |
4,554 |
$268K |
| D0274 |
Bitewings - four radiographic images |
8,620 |
8,438 |
$264K |
| D1351 |
Sealant - per tooth |
13,019 |
2,424 |
$254K |
| D1354 |
|
10,071 |
2,760 |
$248K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,805 |
2,057 |
$243K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,263 |
1,400 |
$217K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,227 |
4,127 |
$214K |
| D0220 |
Intraoral - periapical first radiographic image |
8,295 |
7,953 |
$113K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
110 |
109 |
$101K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
663 |
575 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,886 |
4,812 |
$58K |
| D2950 |
|
351 |
317 |
$45K |
| D0272 |
Bitewings - two radiographic images |
1,620 |
1,604 |
$44K |
| D9920 |
|
1,982 |
1,925 |
$37K |
| D1330 |
|
2,127 |
2,058 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
615 |
605 |
$29K |
| D3120 |
|
798 |
652 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,992 |
1,248 |
$20K |
| D1352 |
|
248 |
159 |
$19K |
| D0270 |
|
1,360 |
1,330 |
$18K |
| D2940 |
|
518 |
258 |
$15K |
| D2335 |
|
65 |
43 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
177 |
166 |
$7K |
| D2394 |
|
30 |
28 |
$5K |
| D9110 |
|
109 |
107 |
$4K |
| D0460 |
|
139 |
117 |
$3K |
| D2331 |
|
30 |
24 |
$3K |
| D2332 |
|
25 |
17 |
$2K |
| D4910 |
|
12 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
26 |
$1K |
| D4341 |
|
28 |
13 |
$1K |
| D0190 |
|
12 |
12 |
$265.92 |
| D9986 |
|
1,124 |
1,100 |
$0.00 |
| D9987 |
|
128 |
126 |
$0.00 |