| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
36,171 |
34,783 |
$1.55M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,611 |
4,629 |
$987K |
| D1208 |
Topical application of fluoride, excluding varnish |
35,968 |
34,586 |
$971K |
| D0120 |
Periodic oral evaluation - established patient |
26,924 |
26,022 |
$883K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,996 |
3,309 |
$510K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,235 |
7,878 |
$486K |
| D1351 |
Sealant - per tooth |
12,501 |
3,291 |
$449K |
| D8670 |
Periodic orthodontic treatment visit |
5,421 |
5,341 |
$438K |
| D0330 |
Panoramic radiographic image |
3,951 |
3,767 |
$298K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,924 |
4,468 |
$273K |
| D0272 |
Bitewings - two radiographic images |
8,807 |
8,488 |
$262K |
| D0274 |
Bitewings - four radiographic images |
4,897 |
4,685 |
$217K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,259 |
746 |
$134K |
| D0140 |
Limited oral evaluation - problem focused |
2,891 |
2,748 |
$130K |
| D7111 |
|
1,094 |
642 |
$93K |
| D8660 |
|
1,639 |
1,598 |
$51K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
98 |
69 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
745 |
717 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
87 |
64 |
$12K |
| D3110 |
|
118 |
57 |
$12K |
| D0470 |
|
35 |
30 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
12 |
$216.58 |