| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,896 |
13,396 |
$338K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,431 |
3,934 |
$283K |
| D0120 |
Periodic oral evaluation - established patient |
14,691 |
14,115 |
$235K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,650 |
2,751 |
$147K |
| D1110 |
Prophylaxis - adult |
5,334 |
5,059 |
$145K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,937 |
10,579 |
$130K |
| D0274 |
Bitewings - four radiographic images |
6,531 |
6,212 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,816 |
4,602 |
$109K |
| D0272 |
Bitewings - two radiographic images |
8,278 |
7,935 |
$104K |
| D1206 |
Topical application of fluoride varnish |
8,362 |
7,945 |
$89K |
| D1351 |
Sealant - per tooth |
4,817 |
1,727 |
$77K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
712 |
377 |
$70K |
| D0330 |
Panoramic radiographic image |
3,645 |
3,463 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
8,823 |
8,230 |
$62K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
877 |
338 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,801 |
2,444 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,128 |
5,494 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
879 |
760 |
$17K |
| D7240 |
Removal of impacted tooth - completely bony |
35 |
13 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
243 |
239 |
$6K |
| D2394 |
|
34 |
12 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
26 |
$1K |
| D0350 |
|
87 |
83 |
$1K |
| D1999 |
|
899 |
813 |
$484.00 |
| D0270 |
|
57 |
51 |
$297.12 |
| D7111 |
|
21 |
13 |
$240.76 |