| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
27,998 |
27,678 |
$688K |
| D1206 |
Topical application of fluoride varnish |
27,430 |
27,079 |
$450K |
| D0120 |
Periodic oral evaluation - established patient |
29,631 |
29,264 |
$435K |
| D1110 |
Prophylaxis - adult |
8,436 |
8,304 |
$300K |
| D0272 |
Bitewings - two radiographic images |
14,716 |
14,530 |
$227K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,112 |
7,025 |
$170K |
| D9994 |
|
16,758 |
16,211 |
$137K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,973 |
5,801 |
$130K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,578 |
7,501 |
$88K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,849 |
1,412 |
$88K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,864 |
1,323 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,764 |
1,388 |
$71K |
| D1351 |
Sealant - per tooth |
4,856 |
1,438 |
$64K |
| D0240 |
|
8,252 |
4,161 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
1,164 |
1,145 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
2,128 |
2,086 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
5,396 |
5,315 |
$41K |
| D0330 |
Panoramic radiographic image |
565 |
552 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
230 |
187 |
$17K |
| D9630 |
|
1,526 |
1,500 |
$17K |
| D9248 |
|
139 |
135 |
$14K |
| D2140 |
|
204 |
153 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,321 |
1,067 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
90 |
70 |
$5K |
| D9310 |
|
74 |
74 |
$5K |
| D1354 |
|
1,377 |
665 |
$3K |
| D0274 |
Bitewings - four radiographic images |
390 |
390 |
$3K |
| D9992 |
|
283 |
280 |
$1K |
| D3120 |
|
152 |
120 |
$0.00 |