| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
17,923 |
17,324 |
$506K |
| D0120 |
Periodic oral evaluation - established patient |
24,275 |
23,464 |
$453K |
| D7240 |
Removal of impacted tooth - completely bony |
2,423 |
525 |
$405K |
| D1208 |
Topical application of fluoride, excluding varnish |
25,430 |
24,473 |
$371K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,673 |
2,159 |
$269K |
| D1999 |
|
13,452 |
12,340 |
$254K |
| D1110 |
Prophylaxis - adult |
6,426 |
6,154 |
$238K |
| D1351 |
Sealant - per tooth |
9,143 |
2,967 |
$202K |
| D0272 |
Bitewings - two radiographic images |
12,238 |
11,825 |
$201K |
| D0330 |
Panoramic radiographic image |
3,607 |
3,492 |
$168K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,213 |
6,563 |
$152K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,352 |
382 |
$99K |
| D0274 |
Bitewings - four radiographic images |
3,935 |
3,792 |
$89K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,298 |
870 |
$77K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,433 |
903 |
$73K |
| D9222 |
|
669 |
550 |
$72K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
692 |
538 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,807 |
1,644 |
$45K |
| D0240 |
|
2,542 |
1,392 |
$40K |
| D1354 |
|
1,268 |
623 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,045 |
1,001 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,199 |
1,986 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
145 |
107 |
$14K |
| D1206 |
Topical application of fluoride varnish |
845 |
828 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
732 |
261 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
123 |
112 |
$3K |
| D9612 |
|
50 |
50 |
$0.00 |
| D9610 |
|
277 |
218 |
$0.00 |