| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,576 |
7,396 |
$316K |
| D1206 |
Topical application of fluoride varnish |
10,078 |
8,565 |
$303K |
| T1015 |
Clinic visit/encounter, all-inclusive |
2,629 |
2,461 |
$288K |
| D0120 |
Periodic oral evaluation - established patient |
6,649 |
5,693 |
$119K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,661 |
1,100 |
$116K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,197 |
795 |
$111K |
| D0330 |
Panoramic radiographic image |
2,038 |
1,859 |
$93K |
| D1351 |
Sealant - per tooth |
4,280 |
1,498 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,517 |
2,206 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,202 |
841 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,100 |
711 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,969 |
1,762 |
$44K |
| D0272 |
Bitewings - two radiographic images |
2,043 |
1,727 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,073 |
939 |
$29K |
| D1110 |
Prophylaxis - adult |
710 |
646 |
$26K |
| D1354 |
|
1,259 |
300 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
709 |
632 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,485 |
1,316 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
707 |
607 |
$16K |
| D7111 |
|
217 |
159 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
207 |
143 |
$9K |
| D9310 |
|
507 |
373 |
$5K |
| D2140 |
|
106 |
76 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
470 |
424 |
$4K |
| D0270 |
|
258 |
219 |
$3K |
| D0240 |
|
75 |
75 |
$2K |
| D9992 |
|
224 |
107 |
$2K |