| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
22,820 |
22,625 |
$652K |
| D0120 |
Periodic oral evaluation - established patient |
30,516 |
30,229 |
$517K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,481 |
3,585 |
$511K |
| D1208 |
Topical application of fluoride, excluding varnish |
27,163 |
26,912 |
$481K |
| D1110 |
Prophylaxis - adult |
10,145 |
10,044 |
$392K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,868 |
3,083 |
$322K |
| D1351 |
Sealant - per tooth |
7,549 |
2,478 |
$211K |
| D0272 |
Bitewings - two radiographic images |
9,866 |
9,780 |
$173K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,385 |
4,249 |
$131K |
| D0274 |
Bitewings - four radiographic images |
4,207 |
4,170 |
$96K |
| D1206 |
Topical application of fluoride varnish |
5,451 |
5,403 |
$94K |
| D0330 |
Panoramic radiographic image |
1,843 |
1,828 |
$84K |
| D1354 |
|
3,035 |
1,313 |
$45K |
| D9248 |
|
311 |
301 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
504 |
305 |
$26K |
| D0240 |
|
2,107 |
1,082 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,923 |
1,894 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
803 |
798 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
612 |
612 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
55 |
24 |
$4K |
| D1355 |
|
53 |
30 |
$826.80 |
| D0145 |
Oral evaluation for a patient under three years of age |
38 |
38 |
$812.10 |
| D0230 |
Intraoral - periapical each additional radiographic image |
38 |
13 |
$391.30 |