| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,692 |
7,386 |
$312K |
| D1351 |
Sealant - per tooth |
2,771 |
1,909 |
$241K |
| D0120 |
Periodic oral evaluation - established patient |
8,617 |
8,290 |
$230K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,816 |
5,586 |
$150K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,775 |
1,423 |
$133K |
| D0274 |
Bitewings - four radiographic images |
3,279 |
3,176 |
$59K |
| D1110 |
Prophylaxis - adult |
1,362 |
1,338 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,051 |
1,977 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
6,372 |
6,064 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,308 |
1,254 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,646 |
5,396 |
$24K |
| D9110 |
|
377 |
355 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
705 |
685 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
200 |
177 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,590 |
1,490 |
$16K |
| D4341 |
|
56 |
41 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
220 |
191 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
349 |
338 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
75 |
64 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
47 |
35 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
61 |
51 |
$2K |