| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,575 |
10,334 |
$453K |
| D0140 |
Limited oral evaluation - problem focused |
10,329 |
9,457 |
$356K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,378 |
1,945 |
$305K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,175 |
9,957 |
$275K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,201 |
3,135 |
$185K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,897 |
1,166 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
4,206 |
4,147 |
$136K |
| D0274 |
Bitewings - four radiographic images |
3,840 |
3,710 |
$133K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,721 |
1,003 |
$133K |
| D1351 |
Sealant - per tooth |
3,231 |
949 |
$120K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,764 |
4,567 |
$100K |
| D0330 |
Panoramic radiographic image |
1,345 |
1,312 |
$93K |
| D0220 |
Intraoral - periapical first radiographic image |
6,243 |
5,908 |
$88K |
| D1110 |
Prophylaxis - adult |
1,765 |
1,675 |
$54K |
| D0272 |
Bitewings - two radiographic images |
1,374 |
1,354 |
$40K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
564 |
398 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
203 |
154 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,715 |
1,630 |
$25K |
| D2140 |
|
183 |
129 |
$9K |
| D3110 |
|
42 |
38 |
$4K |
| D2335 |
|
24 |
15 |
$2K |
| D2332 |
|
18 |
12 |
$2K |
| D2940 |
|
35 |
30 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
12 |
$764.40 |