| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,237 |
13,124 |
$346K |
| D0120 |
Periodic oral evaluation - established patient |
13,265 |
13,175 |
$244K |
| D1351 |
Sealant - per tooth |
8,855 |
3,430 |
$207K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,132 |
13,012 |
$181K |
| D0220 |
Intraoral - periapical first radiographic image |
14,323 |
14,188 |
$162K |
| D0272 |
Bitewings - two radiographic images |
7,884 |
7,828 |
$141K |
| D0274 |
Bitewings - four radiographic images |
5,181 |
5,146 |
$141K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,709 |
1,036 |
$122K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,144 |
13,971 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,098 |
3,055 |
$84K |
| D1110 |
Prophylaxis - adult |
3,065 |
3,031 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
842 |
537 |
$49K |
| D9920 |
|
895 |
880 |
$34K |
| D0330 |
Panoramic radiographic image |
910 |
900 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,526 |
1,526 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,259 |
1,224 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
837 |
833 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
105 |
103 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
14 |
$1K |
| D1999 |
|
3,319 |
3,301 |
$1.86 |