| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
23,538 |
20,095 |
$836K |
| D0120 |
Periodic oral evaluation - established patient |
19,012 |
16,191 |
$513K |
| D1206 |
Topical application of fluoride varnish |
22,947 |
19,522 |
$511K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,671 |
2,179 |
$391K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,000 |
3,225 |
$181K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,368 |
2,867 |
$167K |
| D0272 |
Bitewings - two radiographic images |
6,333 |
5,495 |
$157K |
| D1351 |
Sealant - per tooth |
3,896 |
1,053 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,139 |
693 |
$83K |
| D0330 |
Panoramic radiographic image |
1,091 |
947 |
$72K |
| D0140 |
Limited oral evaluation - problem focused |
1,441 |
1,198 |
$52K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
309 |
118 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
352 |
196 |
$35K |
| D0274 |
Bitewings - four radiographic images |
822 |
681 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,922 |
1,410 |
$27K |
| D1354 |
|
143 |
41 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
53 |
15 |
$882.98 |
| D0240 |
|
48 |
28 |
$502.74 |