| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,898 |
12,336 |
$435K |
| D1206 |
Topical application of fluoride varnish |
17,039 |
15,056 |
$315K |
| D0120 |
Periodic oral evaluation - established patient |
13,431 |
11,830 |
$296K |
| D1351 |
Sealant - per tooth |
9,776 |
2,039 |
$263K |
| D1310 |
|
6,759 |
6,111 |
$250K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,829 |
1,003 |
$226K |
| D1330 |
|
6,751 |
6,107 |
$158K |
| D1110 |
Prophylaxis - adult |
3,324 |
2,910 |
$151K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,824 |
1,003 |
$125K |
| D0350 |
|
3,803 |
3,237 |
$108K |
| D1354 |
|
4,634 |
671 |
$90K |
| D0272 |
Bitewings - two radiographic images |
4,680 |
4,153 |
$90K |
| D0603 |
|
8,923 |
7,881 |
$89K |
| D1320 |
|
2,317 |
2,006 |
$70K |
| D0330 |
Panoramic radiographic image |
1,212 |
1,122 |
$66K |
| D0425 |
|
1,499 |
1,347 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,754 |
1,583 |
$58K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,775 |
1,589 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,072 |
1,840 |
$55K |
| D1353 |
|
1,891 |
827 |
$54K |
| D9630 |
|
2,945 |
2,624 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,158 |
1,021 |
$37K |
| D0240 |
|
1,068 |
524 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
198 |
179 |
$7K |
| D9920 |
|
92 |
88 |
$6K |
| D1999 |
|
7,480 |
5,806 |
$5K |
| D0602 |
|
58 |
57 |
$781.23 |