| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,021 |
8,920 |
$228K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,938 |
1,760 |
$227K |
| D1206 |
Topical application of fluoride varnish |
9,855 |
9,750 |
$156K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,735 |
1,042 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
7,255 |
7,171 |
$106K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,476 |
3,282 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,583 |
2,561 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
928 |
542 |
$62K |
| D1351 |
Sealant - per tooth |
1,712 |
640 |
$55K |
| D0272 |
Bitewings - two radiographic images |
3,446 |
3,398 |
$53K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
305 |
201 |
$45K |
| D0330 |
Panoramic radiographic image |
617 |
611 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
3,670 |
3,578 |
$29K |
| D1110 |
Prophylaxis - adult |
794 |
783 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
1,191 |
1,146 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,327 |
2,373 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
303 |
245 |
$8K |
| D0274 |
Bitewings - four radiographic images |
303 |
303 |
$8K |
| D9920 |
|
150 |
143 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
14 |
$2K |
| D0240 |
|
505 |
310 |
$2K |
| D1354 |
|
117 |
54 |
$920.40 |
| D0145 |
Oral evaluation for a patient under three years of age |
40 |
40 |
$0.00 |