| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,491 |
8,091 |
$343K |
| D0120 |
Periodic oral evaluation - established patient |
8,776 |
8,307 |
$240K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,611 |
7,212 |
$194K |
| D1351 |
Sealant - per tooth |
2,908 |
1,790 |
$192K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,956 |
1,656 |
$123K |
| D0274 |
Bitewings - four radiographic images |
7,267 |
6,853 |
$109K |
| D1110 |
Prophylaxis - adult |
1,946 |
1,848 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,047 |
2,877 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
11,415 |
10,725 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,901 |
9,937 |
$51K |
| D1206 |
Topical application of fluoride varnish |
822 |
820 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
275 |
250 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,765 |
1,655 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
884 |
852 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
332 |
314 |
$12K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
14 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
130 |
128 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
30 |
24 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
24 |
$1K |
| D0270 |
|
165 |
152 |
$912.80 |
| D9310 |
|
27 |
27 |
$461.70 |