| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
23,603 |
21,194 |
$920K |
| D0120 |
Periodic oral evaluation - established patient |
19,538 |
17,604 |
$574K |
| D1206 |
Topical application of fluoride varnish |
19,587 |
17,546 |
$477K |
| D8670 |
Periodic orthodontic treatment visit |
5,070 |
4,971 |
$392K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,169 |
2,607 |
$382K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,895 |
3,179 |
$375K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,304 |
1,135 |
$221K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,802 |
3,373 |
$209K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,145 |
305 |
$205K |
| D0272 |
Bitewings - two radiographic images |
7,035 |
6,279 |
$190K |
| D1351 |
Sealant - per tooth |
5,310 |
1,660 |
$181K |
| D0140 |
Limited oral evaluation - problem focused |
4,299 |
3,747 |
$173K |
| D0330 |
Panoramic radiographic image |
2,430 |
2,097 |
$162K |
| D0274 |
Bitewings - four radiographic images |
3,077 |
2,682 |
$120K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,798 |
1,648 |
$96K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,182 |
2,907 |
$79K |
| D8660 |
|
1,551 |
1,524 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
2,712 |
2,316 |
$43K |
| D3110 |
|
413 |
132 |
$39K |
| D1110 |
Prophylaxis - adult |
299 |
260 |
$5K |
| D9920 |
|
77 |
73 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
14 |
$2K |
| D7111 |
|
18 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
72 |
36 |
$1K |
| D9310 |
|
12 |
12 |
$399.84 |
| D1999 |
|
2,182 |
1,953 |
$0.00 |