| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,025 |
7,021 |
$205K |
| D0120 |
Periodic oral evaluation - established patient |
7,113 |
7,113 |
$202K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,939 |
2,633 |
$165K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,390 |
868 |
$122K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,784 |
7,755 |
$116K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,100 |
680 |
$100K |
| D0272 |
Bitewings - two radiographic images |
3,710 |
3,709 |
$72K |
| D1351 |
Sealant - per tooth |
2,458 |
956 |
$71K |
| D0274 |
Bitewings - four radiographic images |
2,186 |
2,185 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,187 |
3,159 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
4,003 |
3,964 |
$48K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
871 |
524 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,128 |
1,128 |
$42K |
| D0330 |
Panoramic radiographic image |
554 |
553 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
554 |
385 |
$29K |
| D1110 |
Prophylaxis - adult |
576 |
576 |
$23K |
| D0240 |
|
968 |
966 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
268 |
253 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
86 |
64 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
52 |
41 |
$7K |
| D2140 |
|
77 |
50 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
55 |
55 |
$2K |
| D1206 |
Topical application of fluoride varnish |
46 |
46 |
$1K |
| D2160 |
|
26 |
13 |
$1K |