| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
24,180 |
23,925 |
$643K |
| D1206 |
Topical application of fluoride varnish |
26,051 |
25,771 |
$442K |
| D0120 |
Periodic oral evaluation - established patient |
23,927 |
23,681 |
$376K |
| D0272 |
Bitewings - two radiographic images |
10,905 |
10,751 |
$182K |
| D1110 |
Prophylaxis - adult |
4,331 |
4,290 |
$153K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,807 |
4,756 |
$127K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,357 |
4,214 |
$115K |
| D9994 |
|
13,473 |
13,013 |
$111K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,557 |
938 |
$94K |
| D1351 |
Sealant - per tooth |
3,014 |
964 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
905 |
628 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
6,724 |
6,626 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,028 |
733 |
$57K |
| D9630 |
|
2,308 |
2,253 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,945 |
3,268 |
$36K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
252 |
189 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
734 |
729 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
712 |
708 |
$15K |
| D0330 |
Panoramic radiographic image |
253 |
252 |
$13K |
| D9990 |
|
654 |
595 |
$13K |
| D9310 |
|
140 |
140 |
$12K |
| D9248 |
|
73 |
72 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,121 |
1,120 |
$7K |
| D0240 |
|
862 |
497 |
$7K |
| D1355 |
|
111 |
49 |
$4K |
| D3120 |
|
168 |
126 |
$3K |
| D1510 |
|
21 |
14 |
$3K |
| D9992 |
|
357 |
354 |
$3K |
| D9920 |
|
18 |
17 |
$1K |
| D0274 |
Bitewings - four radiographic images |
165 |
165 |
$761.76 |
| D1354 |
|
518 |
252 |
$468.00 |