| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
41,358 |
39,289 |
$1.40M |
| D1120 |
Prophylaxis - child |
33,419 |
31,698 |
$1.39M |
| D0120 |
Periodic oral evaluation - established patient |
38,593 |
36,669 |
$776K |
| D1110 |
Prophylaxis - adult |
8,886 |
8,503 |
$509K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,005 |
2,599 |
$414K |
| D1351 |
Sealant - per tooth |
10,422 |
2,192 |
$334K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,394 |
2,096 |
$284K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,458 |
2,363 |
$260K |
| D0272 |
Bitewings - two radiographic images |
10,611 |
10,016 |
$249K |
| D0274 |
Bitewings - four radiographic images |
4,953 |
4,833 |
$165K |
| D0240 |
|
3,372 |
3,130 |
$153K |
| D0140 |
Limited oral evaluation - problem focused |
4,682 |
4,215 |
$151K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,177 |
3,937 |
$144K |
| D0220 |
Intraoral - periapical first radiographic image |
2,442 |
2,282 |
$36K |
| D0330 |
Panoramic radiographic image |
299 |
291 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
75 |
27 |
$10K |
| D9420 |
|
29 |
29 |
$6K |
| D2940 |
|
17 |
12 |
$765.00 |
| D9310 |
|
27 |
17 |
$702.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
12 |
$480.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
17 |
13 |
$178.00 |