| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,994 |
6,892 |
$289K |
| D0120 |
Periodic oral evaluation - established patient |
8,031 |
7,900 |
$226K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,215 |
2,654 |
$219K |
| D4341 |
|
882 |
492 |
$152K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,999 |
1,499 |
$123K |
| D1351 |
Sealant - per tooth |
1,207 |
786 |
$110K |
| D1110 |
Prophylaxis - adult |
2,034 |
2,008 |
$90K |
| D1206 |
Topical application of fluoride varnish |
3,420 |
3,341 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,158 |
3,139 |
$84K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
690 |
475 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,690 |
1,471 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,910 |
2,867 |
$68K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
679 |
596 |
$59K |
| D0274 |
Bitewings - four radiographic images |
3,273 |
3,220 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
2,753 |
2,637 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
7,651 |
7,418 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
1,662 |
1,615 |
$44K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
788 |
712 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,974 |
5,788 |
$35K |
| D2740 |
Crown - porcelain/ceramic |
100 |
85 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,044 |
1,028 |
$11K |
| D2950 |
|
115 |
101 |
$8K |
| D0330 |
Panoramic radiographic image |
309 |
308 |
$7K |
| D2332 |
|
62 |
55 |
$7K |
| D2330 |
|
85 |
78 |
$6K |
| D2331 |
|
44 |
38 |
$3K |
| D2335 |
|
24 |
24 |
$3K |
| D9110 |
|
27 |
27 |
$1K |
| D0270 |
|
121 |
120 |
$659.68 |
| D9310 |
|
13 |
13 |
$205.20 |