| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,279 |
5,818 |
$255K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,709 |
10,933 |
$238K |
| D0120 |
Periodic oral evaluation - established patient |
9,271 |
8,700 |
$217K |
| D1120 |
Prophylaxis - child |
6,401 |
6,044 |
$209K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,629 |
1,546 |
$184K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,060 |
1,734 |
$181K |
| D1351 |
Sealant - per tooth |
5,022 |
1,701 |
$156K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,575 |
3,318 |
$99K |
| D0274 |
Bitewings - four radiographic images |
3,623 |
3,361 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
1,586 |
1,465 |
$89K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,676 |
2,186 |
$75K |
| D0330 |
Panoramic radiographic image |
1,420 |
1,397 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
5,209 |
4,778 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
791 |
460 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,844 |
4,295 |
$42K |
| D1353 |
|
1,869 |
655 |
$42K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
377 |
258 |
$39K |
| D9110 |
|
678 |
612 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,487 |
1,390 |
$24K |
| D2330 |
|
201 |
134 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
122 |
88 |
$10K |
| D2332 |
|
128 |
69 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
154 |
149 |
$3K |
| D1206 |
Topical application of fluoride varnish |
75 |
75 |
$2K |
| D1354 |
|
40 |
14 |
$396.98 |