| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
17,532 |
16,908 |
$386K |
| D0120 |
Periodic oral evaluation - established patient |
15,012 |
14,910 |
$367K |
| D1120 |
Prophylaxis - child |
12,887 |
12,786 |
$366K |
| D1351 |
Sealant - per tooth |
13,168 |
3,170 |
$362K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,919 |
1,247 |
$361K |
| D1110 |
Prophylaxis - adult |
4,018 |
3,991 |
$151K |
| D1999 |
|
8,707 |
8,442 |
$87K |
| D0330 |
Panoramic radiographic image |
2,396 |
2,375 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,368 |
832 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
776 |
520 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,425 |
1,392 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,683 |
1,646 |
$41K |
| D0272 |
Bitewings - two radiographic images |
2,720 |
2,710 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
472 |
317 |
$35K |
| D0145 |
Oral evaluation for a patient under three years of age |
905 |
903 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,173 |
1,169 |
$26K |
| D9248 |
|
648 |
644 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,113 |
1,104 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,265 |
1,260 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,735 |
2,669 |
$17K |
| D2933 |
|
115 |
42 |
$15K |
| D1206 |
Topical application of fluoride varnish |
44 |
44 |
$1K |
| D9420 |
|
12 |
12 |
$960.00 |
| D0160 |
|
14 |
13 |
$0.00 |
| D1330 |
|
69 |
68 |
$0.00 |