| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
27,970 |
27,874 |
$1.42M |
| D0120 |
Periodic oral evaluation - established patient |
33,816 |
33,729 |
$985K |
| D1206 |
Topical application of fluoride varnish |
36,508 |
36,402 |
$965K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,121 |
4,795 |
$841K |
| D1110 |
Prophylaxis - adult |
8,983 |
8,950 |
$613K |
| D1351 |
Sealant - per tooth |
14,449 |
5,457 |
$599K |
| D0272 |
Bitewings - two radiographic images |
10,232 |
10,196 |
$312K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,030 |
2,264 |
$280K |
| D0330 |
Panoramic radiographic image |
3,969 |
3,953 |
$252K |
| D0274 |
Bitewings - four radiographic images |
5,713 |
5,703 |
$251K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,984 |
1,284 |
$183K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,038 |
2,019 |
$120K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,373 |
5,060 |
$113K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
731 |
643 |
$95K |
| D7111 |
|
1,211 |
795 |
$94K |
| D0220 |
Intraoral - periapical first radiographic image |
1,407 |
1,392 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
375 |
373 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
168 |
105 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
74 |
13 |
$11K |
| D0270 |
|
367 |
364 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$406.00 |