| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
21,015 |
20,384 |
$1.31M |
| D1110 |
Prophylaxis - adult |
10,209 |
9,894 |
$651K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,221 |
4,532 |
$418K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,767 |
4,526 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
28,598 |
27,713 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
30,194 |
29,287 |
$118K |
| D1330 |
|
31,167 |
30,227 |
$81K |
| D0330 |
Panoramic radiographic image |
1,635 |
1,571 |
$80K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
661 |
513 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,594 |
1,551 |
$73K |
| D1351 |
Sealant - per tooth |
8,845 |
2,434 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
29,944 |
28,988 |
$69K |
| D0210 |
Intraoral - complete series of radiographic images |
689 |
646 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,163 |
27,555 |
$66K |
| D0272 |
Bitewings - two radiographic images |
23,848 |
23,113 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,373 |
967 |
$51K |
| D9920 |
|
5,064 |
4,836 |
$31K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
157 |
139 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,313 |
1,283 |
$18K |
| D0274 |
Bitewings - four radiographic images |
2,508 |
2,434 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
320 |
234 |
$13K |
| D7111 |
|
88 |
61 |
$5K |
| D1999 |
|
252 |
241 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
53 |
53 |
$239.04 |