| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,667 |
6,977 |
$322K |
| D0120 |
Periodic oral evaluation - established patient |
7,240 |
6,551 |
$155K |
| D1206 |
Topical application of fluoride varnish |
4,365 |
3,806 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,144 |
741 |
$116K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,179 |
3,928 |
$116K |
| D1351 |
Sealant - per tooth |
3,462 |
1,007 |
$108K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,152 |
612 |
$92K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,105 |
664 |
$81K |
| D0330 |
Panoramic radiographic image |
1,007 |
979 |
$59K |
| D0272 |
Bitewings - two radiographic images |
2,365 |
2,138 |
$54K |
| D1110 |
Prophylaxis - adult |
857 |
762 |
$48K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
363 |
157 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,162 |
1,048 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
928 |
830 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
777 |
683 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
466 |
429 |
$16K |
| D1310 |
|
448 |
286 |
$15K |
| T1015 |
Clinic visit/encounter, all-inclusive |
149 |
148 |
$14K |
| D1330 |
|
361 |
253 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
725 |
640 |
$10K |
| D9420 |
|
25 |
16 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
77 |
76 |
$2K |
| D0240 |
|
62 |
61 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
80 |
55 |
$807.00 |