| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
20,039 |
19,594 |
$817K |
| D0120 |
Periodic oral evaluation - established patient |
18,739 |
18,304 |
$522K |
| D1351 |
Sealant - per tooth |
5,945 |
4,285 |
$445K |
| D1206 |
Topical application of fluoride varnish |
13,998 |
13,829 |
$367K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,288 |
2,810 |
$219K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,513 |
5,229 |
$137K |
| D0274 |
Bitewings - four radiographic images |
5,242 |
5,052 |
$94K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,249 |
1,191 |
$80K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,910 |
1,668 |
$76K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,368 |
1,179 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,647 |
2,539 |
$60K |
| D0272 |
Bitewings - two radiographic images |
4,962 |
4,807 |
$50K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
541 |
523 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,490 |
4,137 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
5,743 |
5,449 |
$34K |
| D1110 |
Prophylaxis - adult |
786 |
719 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
1,391 |
1,331 |
$24K |
| D9310 |
|
133 |
133 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
28 |
$105.10 |