| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,068 |
3,935 |
$165K |
| D0120 |
Periodic oral evaluation - established patient |
4,189 |
4,041 |
$116K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,389 |
1,084 |
$103K |
| D1206 |
Topical application of fluoride varnish |
3,022 |
2,900 |
$77K |
| D1351 |
Sealant - per tooth |
703 |
467 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,664 |
1,607 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,863 |
1,749 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
514 |
406 |
$28K |
| D1110 |
Prophylaxis - adult |
607 |
605 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
236 |
171 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,274 |
1,220 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
3,357 |
3,194 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
366 |
263 |
$20K |
| D9110 |
|
314 |
276 |
$16K |
| D4341 |
|
73 |
49 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
499 |
494 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,415 |
2,290 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
112 |
97 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
286 |
283 |
$9K |
| D0272 |
Bitewings - two radiographic images |
946 |
922 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
294 |
273 |
$8K |
| D0330 |
Panoramic radiographic image |
197 |
193 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13 |
13 |
$880.80 |
| D0270 |
|
27 |
26 |
$151.20 |
| D1999 |
|
946 |
801 |
$0.00 |