| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
18,938 |
18,714 |
$590K |
| D1206 |
Topical application of fluoride varnish |
26,953 |
26,609 |
$520K |
| D0120 |
Periodic oral evaluation - established patient |
24,004 |
23,703 |
$448K |
| D1110 |
Prophylaxis - adult |
8,232 |
8,131 |
$358K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,603 |
9,684 |
$333K |
| D1351 |
Sealant - per tooth |
10,747 |
3,763 |
$324K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,007 |
2,822 |
$322K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,016 |
2,622 |
$267K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,828 |
1,289 |
$233K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,890 |
1,774 |
$179K |
| D0272 |
Bitewings - two radiographic images |
8,020 |
7,924 |
$148K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,778 |
1,002 |
$132K |
| D0274 |
Bitewings - four radiographic images |
4,774 |
4,717 |
$121K |
| D0210 |
Intraoral - complete series of radiographic images |
2,809 |
2,694 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,376 |
3,336 |
$98K |
| D0240 |
|
8,975 |
4,512 |
$95K |
| D9630 |
|
4,366 |
4,327 |
$76K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
543 |
451 |
$56K |
| D0330 |
Panoramic radiographic image |
784 |
783 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
3,274 |
3,205 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
979 |
958 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,468 |
850 |
$19K |
| D9920 |
|
267 |
258 |
$15K |
| D3120 |
|
800 |
513 |
$14K |
| D2140 |
|
268 |
182 |
$14K |
| D2330 |
|
164 |
94 |
$10K |
| D2331 |
|
38 |
27 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
176 |
176 |
$4K |
| D2160 |
|
32 |
26 |
$2K |
| D9310 |
|
27 |
27 |
$2K |
| D2335 |
|
16 |
14 |
$2K |
| D1354 |
|
125 |
41 |
$2K |
| D7111 |
|
22 |
15 |
$526.46 |