| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,664 |
12,209 |
$626K |
| D1206 |
Topical application of fluoride varnish |
13,735 |
13,241 |
$346K |
| D0120 |
Periodic oral evaluation - established patient |
11,090 |
10,684 |
$313K |
| D9450 |
|
11,728 |
10,202 |
$244K |
| D0272 |
Bitewings - two radiographic images |
4,397 |
4,220 |
$128K |
| D1354 |
|
6,548 |
1,697 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,102 |
1,070 |
$62K |
| D1351 |
Sealant - per tooth |
1,458 |
410 |
$55K |
| D1110 |
Prophylaxis - adult |
774 |
722 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,436 |
1,226 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
735 |
714 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
159 |
113 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
140 |
72 |
$13K |
| D0274 |
Bitewings - four radiographic images |
256 |
244 |
$11K |
| D0330 |
Panoramic radiographic image |
94 |
92 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
25 |
14 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
12 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
162 |
134 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
50 |
49 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
30 |
27 |
$1K |