| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
23,882 |
23,426 |
$1.03M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,957 |
4,200 |
$726K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,195 |
1,817 |
$666K |
| D1206 |
Topical application of fluoride varnish |
26,163 |
25,665 |
$644K |
| D0120 |
Periodic oral evaluation - established patient |
21,363 |
20,953 |
$628K |
| D1351 |
Sealant - per tooth |
16,743 |
4,203 |
$555K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,431 |
2,399 |
$322K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,862 |
1,752 |
$306K |
| D0140 |
Limited oral evaluation - problem focused |
4,175 |
3,915 |
$184K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,435 |
3,373 |
$180K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,603 |
7,757 |
$156K |
| D0272 |
Bitewings - two radiographic images |
9,365 |
9,193 |
$142K |
| D3120 |
|
2,945 |
1,783 |
$102K |
| D1330 |
|
13,737 |
13,472 |
$82K |
| D1110 |
Prophylaxis - adult |
1,057 |
1,033 |
$62K |
| D2929 |
|
361 |
136 |
$56K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
314 |
281 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,045 |
1,019 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
577 |
561 |
$23K |
| D0240 |
|
1,235 |
1,202 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,280 |
1,242 |
$12K |
| D0330 |
Panoramic radiographic image |
138 |
135 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$299.00 |