| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,217 |
13,059 |
$483K |
| D0120 |
Periodic oral evaluation - established patient |
15,513 |
15,282 |
$444K |
| D1110 |
Prophylaxis - adult |
7,094 |
6,962 |
$356K |
| D1351 |
Sealant - per tooth |
10,283 |
3,299 |
$308K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,863 |
12,666 |
$268K |
| D0330 |
Panoramic radiographic image |
4,014 |
3,955 |
$217K |
| D0272 |
Bitewings - two radiographic images |
10,027 |
9,852 |
$215K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,435 |
402 |
$186K |
| D1206 |
Topical application of fluoride varnish |
5,633 |
5,576 |
$144K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,832 |
2,880 |
$142K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,817 |
1,794 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,215 |
399 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
5,089 |
4,768 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
718 |
319 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
655 |
294 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,189 |
3,192 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
964 |
924 |
$36K |
| D1354 |
|
2,342 |
439 |
$31K |
| D9920 |
|
467 |
426 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
609 |
585 |
$9K |
| D1515 |
|
52 |
28 |
$6K |
| D1516 |
|
17 |
12 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
25 |
13 |
$2K |
| D3110 |
|
72 |
37 |
$2K |
| D1999 |
|
14 |
13 |
$25.00 |
| D9986 |
|
1,530 |
1,436 |
$0.00 |