| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
25,523 |
23,403 |
$995K |
| D0120 |
Periodic oral evaluation - established patient |
21,480 |
19,546 |
$609K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,712 |
2,373 |
$421K |
| D1206 |
Topical application of fluoride varnish |
12,214 |
11,439 |
$305K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,218 |
11,008 |
$284K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,721 |
3,428 |
$196K |
| D0274 |
Bitewings - four radiographic images |
3,692 |
3,358 |
$135K |
| D0272 |
Bitewings - two radiographic images |
4,843 |
4,425 |
$131K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,821 |
945 |
$131K |
| D0330 |
Panoramic radiographic image |
1,957 |
1,690 |
$120K |
| D1351 |
Sealant - per tooth |
2,907 |
798 |
$91K |
| D0140 |
Limited oral evaluation - problem focused |
2,312 |
2,011 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
5,045 |
4,475 |
$76K |
| D7140 |
Extraction, erupted tooth or exposed root |
732 |
347 |
$66K |
| D1110 |
Prophylaxis - adult |
1,541 |
1,377 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,612 |
1,416 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
400 |
377 |
$22K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
117 |
52 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
356 |
303 |
$13K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
13 |
$12K |
| D1354 |
|
687 |
386 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
81 |
24 |
$7K |
| D7962 |
|
15 |
12 |
$3K |
| D0240 |
|
138 |
99 |
$3K |
| D8670 |
Periodic orthodontic treatment visit |
36 |
36 |
$2K |
| D9310 |
|
13 |
12 |
$352.92 |