| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
28,142 |
27,966 |
$985K |
| D0120 |
Periodic oral evaluation - established patient |
30,974 |
30,798 |
$771K |
| D1206 |
Topical application of fluoride varnish |
28,427 |
28,256 |
$717K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,158 |
2,807 |
$292K |
| D0330 |
Panoramic radiographic image |
4,690 |
4,661 |
$289K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,492 |
721 |
$285K |
| D1351 |
Sealant - per tooth |
7,608 |
2,411 |
$284K |
| D1110 |
Prophylaxis - adult |
7,221 |
7,160 |
$252K |
| D0272 |
Bitewings - two radiographic images |
9,595 |
9,539 |
$232K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,438 |
1,783 |
$211K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,669 |
5,631 |
$208K |
| D0274 |
Bitewings - four radiographic images |
5,689 |
5,649 |
$183K |
| D0220 |
Intraoral - periapical first radiographic image |
4,269 |
4,215 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
422 |
251 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,336 |
1,297 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
570 |
561 |
$15K |
| D9248 |
|
268 |
266 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
217 |
204 |
$5K |
| D2330 |
|
47 |
27 |
$3K |