| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,373 |
7,281 |
$324K |
| D1206 |
Topical application of fluoride varnish |
11,087 |
10,909 |
$276K |
| D1351 |
Sealant - per tooth |
8,052 |
1,919 |
$272K |
| D0120 |
Periodic oral evaluation - established patient |
8,555 |
8,429 |
$255K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,894 |
947 |
$238K |
| D1110 |
Prophylaxis - adult |
2,651 |
2,604 |
$162K |
| D0140 |
Limited oral evaluation - problem focused |
2,216 |
2,088 |
$98K |
| D0330 |
Panoramic radiographic image |
2,039 |
2,017 |
$88K |
| D0272 |
Bitewings - two radiographic images |
5,257 |
5,184 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,473 |
1,457 |
$78K |
| D7140 |
Extraction, erupted tooth or exposed root |
698 |
459 |
$77K |
| D0274 |
Bitewings - four radiographic images |
2,893 |
2,847 |
$66K |
| D1330 |
|
5,424 |
5,354 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,254 |
1,238 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,052 |
1,013 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
37 |
25 |
$6K |
| D3120 |
|
104 |
52 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
139 |
134 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
14 |
$2K |
| D0240 |
|
15 |
15 |
$144.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$131.20 |