| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,115 |
13,657 |
$406K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,880 |
1,587 |
$318K |
| D0120 |
Periodic oral evaluation - established patient |
11,522 |
11,183 |
$240K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,895 |
1,547 |
$163K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,288 |
8,791 |
$145K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,079 |
1,449 |
$130K |
| D1206 |
Topical application of fluoride varnish |
6,943 |
6,902 |
$129K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,475 |
4,296 |
$122K |
| D0330 |
Panoramic radiographic image |
2,183 |
2,113 |
$102K |
| D0272 |
Bitewings - two radiographic images |
5,146 |
4,951 |
$95K |
| D1110 |
Prophylaxis - adult |
2,143 |
2,059 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
819 |
621 |
$63K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,394 |
3,232 |
$60K |
| D1351 |
Sealant - per tooth |
1,889 |
760 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,467 |
1,412 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
1,555 |
1,501 |
$18K |
| D9310 |
|
347 |
336 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
171 |
163 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
108 |
99 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31 |
13 |
$162.00 |