| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,872 |
9,718 |
$450K |
| D0120 |
Periodic oral evaluation - established patient |
8,051 |
7,927 |
$313K |
| D1206 |
Topical application of fluoride varnish |
9,761 |
9,600 |
$310K |
| D1351 |
Sealant - per tooth |
8,368 |
1,652 |
$274K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,093 |
770 |
$90K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,197 |
3,677 |
$85K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,425 |
977 |
$78K |
| D0272 |
Bitewings - two radiographic images |
4,470 |
4,419 |
$77K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
601 |
395 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,268 |
1,239 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
5,125 |
4,963 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
878 |
848 |
$39K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
492 |
364 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
708 |
496 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,692 |
4,092 |
$33K |
| D0240 |
|
1,199 |
1,199 |
$33K |
| D0330 |
Panoramic radiographic image |
689 |
680 |
$30K |
| D0603 |
|
2,471 |
2,402 |
$24K |
| D0274 |
Bitewings - four radiographic images |
940 |
924 |
$13K |
| D0601 |
|
967 |
957 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
84 |
84 |
$6K |
| D0602 |
|
548 |
548 |
$5K |
| D1110 |
Prophylaxis - adult |
194 |
189 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
107 |
107 |
$2K |
| D1354 |
|
426 |
165 |
$2K |
| D2140 |
|
18 |
14 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$1K |