| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,060 |
8,983 |
$247K |
| D1206 |
Topical application of fluoride varnish |
10,939 |
10,845 |
$181K |
| D0120 |
Periodic oral evaluation - established patient |
9,444 |
9,368 |
$153K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,510 |
1,135 |
$151K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,467 |
1,005 |
$148K |
| D1351 |
Sealant - per tooth |
3,210 |
1,042 |
$78K |
| D1110 |
Prophylaxis - adult |
1,947 |
1,930 |
$64K |
| D0272 |
Bitewings - two radiographic images |
3,688 |
3,653 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,312 |
2,190 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,705 |
1,686 |
$41K |
| D0330 |
Panoramic radiographic image |
893 |
882 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
3,738 |
3,682 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,383 |
1,371 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,111 |
2,999 |
$26K |
| D0240 |
|
2,078 |
1,137 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
368 |
196 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
327 |
318 |
$5K |
| D3120 |
|
94 |
39 |
$2K |
| D1354 |
|
455 |
111 |
$795.60 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
18 |
$0.00 |