| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,245 |
15,848 |
$550K |
| D0120 |
Periodic oral evaluation - established patient |
19,688 |
19,195 |
$488K |
| D1206 |
Topical application of fluoride varnish |
20,815 |
20,269 |
$451K |
| D1351 |
Sealant - per tooth |
9,045 |
2,596 |
$296K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,872 |
2,534 |
$287K |
| D1110 |
Prophylaxis - adult |
4,958 |
4,812 |
$212K |
| D0330 |
Panoramic radiographic image |
6,369 |
6,194 |
$181K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,768 |
2,061 |
$171K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,038 |
4,589 |
$147K |
| D0272 |
Bitewings - two radiographic images |
7,168 |
6,982 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,462 |
3,379 |
$100K |
| D1353 |
|
3,292 |
1,098 |
$88K |
| D0274 |
Bitewings - four radiographic images |
3,539 |
3,428 |
$87K |
| D0220 |
Intraoral - periapical first radiographic image |
3,157 |
3,060 |
$38K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,131 |
1,111 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
380 |
256 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
230 |
167 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
622 |
599 |
$14K |
| D1354 |
|
289 |
98 |
$3K |
| D0270 |
|
13 |
12 |
$11.82 |
| D1330 |
|
1,887 |
1,841 |
$0.00 |