| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
24,810 |
7,279 |
$1.59M |
| D1120 |
Prophylaxis - child |
13,398 |
11,894 |
$372K |
| D1206 |
Topical application of fluoride varnish |
19,919 |
17,677 |
$357K |
| D1351 |
Sealant - per tooth |
13,957 |
4,036 |
$329K |
| D0120 |
Periodic oral evaluation - established patient |
17,797 |
15,484 |
$317K |
| D1110 |
Prophylaxis - adult |
6,783 |
6,012 |
$265K |
| D0240 |
|
18,076 |
7,420 |
$233K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,271 |
544 |
$158K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,276 |
1,783 |
$148K |
| D0330 |
Panoramic radiographic image |
2,727 |
2,393 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,218 |
1,174 |
$117K |
| D0272 |
Bitewings - two radiographic images |
5,395 |
4,799 |
$103K |
| D0274 |
Bitewings - four radiographic images |
3,578 |
3,141 |
$99K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,193 |
2,345 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
730 |
434 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,523 |
1,367 |
$48K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
655 |
384 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
1,572 |
1,353 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
719 |
663 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,229 |
1,055 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
515 |
471 |
$14K |
| D2140 |
|
138 |
93 |
$5K |
| D9920 |
|
118 |
97 |
$4K |
| D2330 |
|
73 |
27 |
$2K |
| D0250 |
|
140 |
123 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
40 |
$745.59 |
| D1999 |
|
638 |
426 |
$165.00 |
| D9430 |
|
12 |
12 |
$60.00 |
| D0350 |
|
2,239 |
1,914 |
$0.00 |
| D0603 |
|
14,832 |
12,643 |
$0.00 |
| D0601 |
|
422 |
358 |
$0.00 |
| D0602 |
|
309 |
252 |
$0.00 |
| D1330 |
|
8,028 |
6,931 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
13 |
$0.00 |