| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,997 |
11,997 |
$418K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,143 |
1,579 |
$322K |
| D0120 |
Periodic oral evaluation - established patient |
13,581 |
13,581 |
$317K |
| D1110 |
Prophylaxis - adult |
4,870 |
4,870 |
$245K |
| D1206 |
Topical application of fluoride varnish |
14,422 |
14,422 |
$237K |
| D0274 |
Bitewings - four radiographic images |
5,567 |
5,567 |
$154K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,778 |
1,180 |
$143K |
| D0272 |
Bitewings - two radiographic images |
7,402 |
7,402 |
$140K |
| D0330 |
Panoramic radiographic image |
2,231 |
2,231 |
$113K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,973 |
2,848 |
$96K |
| D1351 |
Sealant - per tooth |
2,793 |
935 |
$83K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,587 |
1,587 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,506 |
1,506 |
$61K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
416 |
130 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
2,756 |
2,740 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,949 |
1,949 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
733 |
731 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,416 |
1,310 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
137 |
81 |
$14K |
| D9420 |
|
52 |
52 |
$5K |
| D2140 |
|
25 |
14 |
$2K |
| D7111 |
|
21 |
14 |
$1K |
| D2330 |
|
16 |
12 |
$1K |