| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,320 |
12,780 |
$665K |
| D1206 |
Topical application of fluoride varnish |
15,278 |
14,563 |
$389K |
| D0120 |
Periodic oral evaluation - established patient |
12,869 |
12,220 |
$363K |
| D1351 |
Sealant - per tooth |
4,385 |
1,278 |
$177K |
| D0272 |
Bitewings - two radiographic images |
5,054 |
4,873 |
$149K |
| D8670 |
Periodic orthodontic treatment visit |
522 |
467 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,099 |
2,023 |
$112K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
889 |
548 |
$102K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,063 |
591 |
$96K |
| D1110 |
Prophylaxis - adult |
1,479 |
1,340 |
$86K |
| D0140 |
Limited oral evaluation - problem focused |
1,398 |
1,306 |
$58K |
| D0274 |
Bitewings - four radiographic images |
1,383 |
1,270 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,439 |
2,238 |
$48K |
| D0330 |
Panoramic radiographic image |
761 |
749 |
$43K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
219 |
139 |
$42K |
| D9310 |
|
371 |
353 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
893 |
820 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
138 |
102 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
134 |
118 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
75 |
51 |
$8K |
| D8660 |
|
159 |
153 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
13 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
45 |
44 |
$1K |
| D1354 |
|
44 |
12 |
$615.00 |
| D1999 |
|
2,345 |
2,166 |
$0.00 |
| D0603 |
|
1,256 |
1,244 |
$0.00 |
| D0602 |
|
140 |
140 |
$0.00 |
| D0601 |
|
120 |
119 |
$0.00 |