| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,344 |
4,912 |
$153K |
| D1110 |
Prophylaxis - adult |
3,233 |
3,055 |
$134K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,407 |
3,319 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
5,454 |
4,898 |
$110K |
| D0272 |
Bitewings - two radiographic images |
5,530 |
5,160 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,000 |
5,578 |
$101K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
587 |
343 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,115 |
1,032 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
4,555 |
4,217 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,807 |
904 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
849 |
832 |
$57K |
| D1351 |
Sealant - per tooth |
2,508 |
870 |
$56K |
| D1206 |
Topical application of fluoride varnish |
2,196 |
2,019 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,971 |
3,288 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,588 |
1,433 |
$35K |
| D0330 |
Panoramic radiographic image |
1,622 |
1,530 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
562 |
534 |
$16K |
| D0602 |
|
3,576 |
3,508 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
191 |
116 |
$11K |
| D0274 |
Bitewings - four radiographic images |
515 |
509 |
$8K |
| D0603 |
|
2,873 |
2,835 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
15 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
66 |
45 |
$2K |
| D2140 |
|
73 |
39 |
$2K |
| D0601 |
|
381 |
369 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
12 |
$0.00 |