| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
19,152 |
18,724 |
$858K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,721 |
3,766 |
$853K |
| D0120 |
Periodic oral evaluation - established patient |
18,663 |
18,312 |
$624K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,000 |
1,194 |
$546K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,300 |
3,069 |
$481K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,462 |
6,261 |
$460K |
| D1110 |
Prophylaxis - adult |
5,401 |
5,300 |
$393K |
| D0272 |
Bitewings - two radiographic images |
10,675 |
10,424 |
$385K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,941 |
15,633 |
$382K |
| D1351 |
Sealant - per tooth |
10,124 |
2,817 |
$367K |
| D0274 |
Bitewings - four radiographic images |
7,835 |
7,667 |
$336K |
| D0330 |
Panoramic radiographic image |
3,981 |
3,871 |
$287K |
| D1206 |
Topical application of fluoride varnish |
8,288 |
8,058 |
$228K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,834 |
4,409 |
$206K |
| D0220 |
Intraoral - periapical first radiographic image |
8,924 |
8,634 |
$160K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,021 |
6,789 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
1,436 |
1,387 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
234 |
176 |
$43K |
| D7240 |
Removal of impacted tooth - completely bony |
112 |
41 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
318 |
251 |
$34K |
| D8670 |
Periodic orthodontic treatment visit |
1,827 |
1,816 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
87 |
58 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
103 |
103 |
$9K |
| D7230 |
|
19 |
13 |
$5K |
| D9310 |
|
26 |
26 |
$3K |
| D8660 |
|
110 |
109 |
$1K |
| D0240 |
|
15 |
12 |
$563.64 |
| D1999 |
|
107 |
97 |
$0.00 |