| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
20,541 |
20,215 |
$1.03M |
| D0120 |
Periodic oral evaluation - established patient |
22,226 |
21,880 |
$637K |
| D1206 |
Topical application of fluoride varnish |
23,814 |
23,446 |
$616K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,524 |
3,337 |
$589K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,279 |
3,069 |
$361K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,626 |
1,905 |
$303K |
| D0272 |
Bitewings - two radiographic images |
9,737 |
9,558 |
$286K |
| D1351 |
Sealant - per tooth |
7,114 |
2,683 |
$277K |
| D1110 |
Prophylaxis - adult |
3,865 |
3,812 |
$260K |
| D0274 |
Bitewings - four radiographic images |
5,729 |
5,629 |
$236K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,292 |
691 |
$235K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,524 |
1,443 |
$232K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,418 |
8,834 |
$185K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,988 |
2,920 |
$169K |
| D0220 |
Intraoral - periapical first radiographic image |
7,126 |
6,897 |
$137K |
| D0330 |
Panoramic radiographic image |
2,700 |
2,655 |
$136K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,233 |
3,938 |
$102K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
366 |
316 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
814 |
752 |
$35K |
| D2140 |
|
110 |
75 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
226 |
217 |
$6K |
| D1354 |
|
172 |
76 |
$3K |
| D0270 |
|
32 |
28 |
$340.00 |