| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
23,957 |
20,236 |
$1.04M |
| D0120 |
Periodic oral evaluation - established patient |
26,228 |
21,772 |
$773K |
| D1206 |
Topical application of fluoride varnish |
29,773 |
24,956 |
$737K |
| D1110 |
Prophylaxis - adult |
4,176 |
3,396 |
$251K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,700 |
939 |
$214K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,578 |
2,308 |
$137K |
| D0330 |
Panoramic radiographic image |
3,096 |
2,710 |
$133K |
| D1351 |
Sealant - per tooth |
3,579 |
744 |
$121K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,222 |
577 |
$116K |
| D0272 |
Bitewings - two radiographic images |
7,029 |
5,992 |
$106K |
| D7140 |
Extraction, erupted tooth or exposed root |
653 |
262 |
$73K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,837 |
3,205 |
$71K |
| D1330 |
|
10,966 |
10,411 |
$67K |
| D0274 |
Bitewings - four radiographic images |
1,991 |
1,677 |
$45K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
224 |
102 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
675 |
542 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
372 |
203 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
399 |
302 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
77 |
74 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
37 |
37 |
$2K |
| D9420 |
|
45 |
42 |
$630.00 |