| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,549 |
7,549 |
$382K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,782 |
2,748 |
$334K |
| D1120 |
Prophylaxis - child |
9,172 |
9,172 |
$322K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,902 |
2,159 |
$297K |
| D0120 |
Periodic oral evaluation - established patient |
11,786 |
11,786 |
$277K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,303 |
6,573 |
$239K |
| D0274 |
Bitewings - four radiographic images |
8,544 |
8,544 |
$236K |
| D1206 |
Topical application of fluoride varnish |
13,362 |
13,362 |
$221K |
| D0220 |
Intraoral - periapical first radiographic image |
14,221 |
14,127 |
$184K |
| D1351 |
Sealant - per tooth |
5,919 |
2,784 |
$179K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,696 |
3,696 |
$153K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,426 |
13,195 |
$145K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
950 |
608 |
$120K |
| D0272 |
Bitewings - two radiographic images |
5,277 |
5,277 |
$100K |
| D0330 |
Panoramic radiographic image |
2,754 |
2,734 |
$96K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,330 |
1,330 |
$62K |
| D0240 |
|
2,566 |
1,352 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,054 |
3,054 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
318 |
229 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
656 |
652 |
$25K |
| D2330 |
|
279 |
191 |
$22K |
| D2332 |
|
20 |
17 |
$2K |