| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
21,688 |
21,672 |
$1.62M |
| D1110 |
Prophylaxis - adult |
10,341 |
10,332 |
$1.26M |
| D0330 |
Panoramic radiographic image |
4,231 |
4,227 |
$325K |
| D0210 |
Intraoral - complete series of radiographic images |
1,357 |
1,357 |
$303K |
| D9420 |
|
911 |
908 |
$266K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,968 |
2,061 |
$224K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,506 |
1,124 |
$203K |
| D8670 |
Periodic orthodontic treatment visit |
2,575 |
2,554 |
$195K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,071 |
7,064 |
$183K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,736 |
1,441 |
$100K |
| D0140 |
Limited oral evaluation - problem focused |
1,834 |
1,820 |
$58K |
| D8660 |
|
955 |
947 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,105 |
672 |
$39K |
| D2932 |
|
93 |
25 |
$21K |
| D1351 |
Sealant - per tooth |
51,477 |
9,356 |
$20K |
| D0274 |
Bitewings - four radiographic images |
9,762 |
9,756 |
$10K |
| D9248 |
|
58 |
58 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,402 |
4,300 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
23,688 |
23,672 |
$5K |
| D1354 |
|
867 |
385 |
$4K |
| D2332 |
|
16 |
12 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
13,542 |
13,383 |
$1K |
| D0272 |
Bitewings - two radiographic images |
17,918 |
17,868 |
$920.13 |
| D2920 |
|
12 |
12 |
$570.33 |
| D0145 |
Oral evaluation for a patient under three years of age |
823 |
822 |
$141.26 |
| D1208 |
Topical application of fluoride, excluding varnish |
23,798 |
23,775 |
$27.10 |
| D0240 |
|
105 |
78 |
$8.70 |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,789 |
9,290 |
$8.19 |
| D1206 |
Topical application of fluoride varnish |
7,916 |
7,914 |
$0.00 |