| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
20,345 |
19,795 |
$673K |
| D0120 |
Periodic oral evaluation - established patient |
20,667 |
20,106 |
$650K |
| D1120 |
Prophylaxis - child |
17,180 |
16,744 |
$582K |
| D1110 |
Prophylaxis - adult |
7,238 |
6,966 |
$353K |
| D1351 |
Sealant - per tooth |
9,145 |
2,525 |
$255K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,765 |
496 |
$224K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,878 |
1,750 |
$206K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,290 |
12,763 |
$205K |
| D0220 |
Intraoral - periapical first radiographic image |
14,383 |
13,891 |
$201K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,123 |
1,325 |
$192K |
| D0272 |
Bitewings - two radiographic images |
7,537 |
7,319 |
$166K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,588 |
3,520 |
$108K |
| D0274 |
Bitewings - four radiographic images |
2,891 |
2,820 |
$95K |
| D0330 |
Panoramic radiographic image |
1,317 |
1,293 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
712 |
388 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,491 |
1,405 |
$37K |
| D9420 |
|
140 |
140 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
401 |
398 |
$12K |
| D1310 |
|
898 |
898 |
$9K |
| D1999 |
|
377 |
352 |
$4K |