| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,303 |
15,996 |
$693K |
| D1206 |
Topical application of fluoride varnish |
24,800 |
24,369 |
$608K |
| D0120 |
Periodic oral evaluation - established patient |
20,673 |
20,322 |
$600K |
| D1351 |
Sealant - per tooth |
10,697 |
2,603 |
$353K |
| D1110 |
Prophylaxis - adult |
5,523 |
5,452 |
$329K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,415 |
2,091 |
$312K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,460 |
1,548 |
$289K |
| D0330 |
Panoramic radiographic image |
2,338 |
2,298 |
$99K |
| D0274 |
Bitewings - four radiographic images |
4,110 |
4,049 |
$91K |
| D0272 |
Bitewings - two radiographic images |
5,613 |
5,530 |
$84K |
| D1330 |
|
12,389 |
12,165 |
$75K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,423 |
3,166 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
754 |
729 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
582 |
578 |
$32K |
| D9310 |
|
351 |
348 |
$17K |
| D8660 |
|
96 |
96 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
158 |
152 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
441 |
435 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
13 |
12 |
$1K |
| D7111 |
|
22 |
15 |
$594.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
24 |
$372.00 |
| D0240 |
|
13 |
13 |
$135.00 |