| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,027 |
10,884 |
$363K |
| D0120 |
Periodic oral evaluation - established patient |
12,427 |
12,262 |
$294K |
| D1206 |
Topical application of fluoride varnish |
9,509 |
9,371 |
$196K |
| D1110 |
Prophylaxis - adult |
3,851 |
3,790 |
$161K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,272 |
1,679 |
$156K |
| D1351 |
Sealant - per tooth |
4,700 |
1,298 |
$127K |
| D0220 |
Intraoral - periapical first radiographic image |
9,486 |
9,355 |
$118K |
| D0272 |
Bitewings - two radiographic images |
6,567 |
6,478 |
$115K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,183 |
5,121 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,593 |
3,543 |
$101K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,562 |
3,315 |
$100K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,722 |
1,265 |
$98K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,137 |
8,908 |
$87K |
| D0210 |
Intraoral - complete series of radiographic images |
1,531 |
1,513 |
$85K |
| D0274 |
Bitewings - four radiographic images |
2,292 |
2,272 |
$61K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
227 |
190 |
$26K |
| D1354 |
|
2,185 |
779 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
410 |
402 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
101 |
89 |
$8K |
| D2330 |
|
41 |
26 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
24 |
$1K |