| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
17,733 |
17,725 |
$802K |
| D0120 |
Periodic oral evaluation - established patient |
24,783 |
24,774 |
$749K |
| D1110 |
Prophylaxis - adult |
12,283 |
12,275 |
$727K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,600 |
4,572 |
$632K |
| D1351 |
Sealant - per tooth |
6,340 |
2,502 |
$422K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,028 |
18,018 |
$292K |
| D1206 |
Topical application of fluoride varnish |
7,575 |
7,571 |
$240K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,137 |
16,133 |
$235K |
| D0274 |
Bitewings - four radiographic images |
6,249 |
6,249 |
$187K |
| D0220 |
Intraoral - periapical first radiographic image |
11,556 |
11,492 |
$173K |
| D0272 |
Bitewings - two radiographic images |
9,171 |
9,166 |
$159K |
| D0210 |
Intraoral - complete series of radiographic images |
2,772 |
2,761 |
$142K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,596 |
4,595 |
$131K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,703 |
1,418 |
$120K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,514 |
2,342 |
$112K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
777 |
648 |
$99K |
| D2752 |
|
136 |
130 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,406 |
1,104 |
$85K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
736 |
601 |
$82K |
| D0270 |
|
2,998 |
2,998 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
2,002 |
1,990 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
205 |
128 |
$26K |
| D0330 |
Panoramic radiographic image |
778 |
778 |
$24K |
| D0240 |
|
972 |
667 |
$20K |
| D2954 |
|
107 |
104 |
$19K |
| D9310 |
|
143 |
143 |
$12K |
| D2330 |
|
149 |
107 |
$10K |
| D2394 |
|
27 |
26 |
$6K |
| D2331 |
|
51 |
38 |
$5K |
| D4341 |
|
60 |
26 |
$4K |
| D9110 |
|
96 |
95 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
101 |
101 |
$2K |
| D0273 |
|
41 |
41 |
$650.64 |
| D9920 |
|
19 |
18 |
$0.00 |