| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,733 |
6,618 |
$309K |
| D0120 |
Periodic oral evaluation - established patient |
12,023 |
11,790 |
$307K |
| D1120 |
Prophylaxis - child |
6,591 |
6,461 |
$227K |
| D0220 |
Intraoral - periapical first radiographic image |
13,843 |
12,892 |
$212K |
| D0272 |
Bitewings - two radiographic images |
9,315 |
9,157 |
$207K |
| D0240 |
|
8,712 |
8,421 |
$191K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,068 |
1,268 |
$169K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,838 |
1,071 |
$140K |
| D1351 |
Sealant - per tooth |
5,294 |
1,942 |
$137K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,164 |
4,677 |
$128K |
| D1206 |
Topical application of fluoride varnish |
6,327 |
6,232 |
$123K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,339 |
777 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,586 |
6,465 |
$115K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,089 |
4,071 |
$86K |
| D0210 |
Intraoral - complete series of radiographic images |
1,312 |
1,291 |
$84K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
589 |
340 |
$80K |
| D2160 |
|
483 |
264 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
1,592 |
1,555 |
$41K |
| D2931 |
|
236 |
212 |
$34K |
| D0602 |
|
8,953 |
8,816 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
999 |
988 |
$31K |
| D2140 |
|
476 |
304 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
305 |
223 |
$19K |
| D0274 |
Bitewings - four radiographic images |
685 |
671 |
$17K |
| D7111 |
|
311 |
233 |
$13K |
| D0330 |
Panoramic radiographic image |
568 |
555 |
$11K |
| D0603 |
|
2,289 |
2,256 |
$10K |
| D2335 |
|
42 |
25 |
$6K |
| D2332 |
|
21 |
12 |
$2K |
| D2950 |
|
32 |
27 |
$1K |
| D0601 |
|
254 |
245 |
$1K |
| D2394 |
|
13 |
12 |
$1K |