| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
47,543 |
46,559 |
$2.05M |
| D1351 |
Sealant - per tooth |
57,010 |
16,945 |
$1.91M |
| D0120 |
Periodic oral evaluation - established patient |
59,348 |
58,160 |
$1.75M |
| D1206 |
Topical application of fluoride varnish |
66,348 |
64,951 |
$1.63M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,453 |
7,402 |
$1.54M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,422 |
4,037 |
$1.31M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,593 |
6,451 |
$914K |
| D1110 |
Prophylaxis - adult |
15,021 |
14,722 |
$906K |
| D0272 |
Bitewings - two radiographic images |
32,042 |
31,348 |
$502K |
| D0220 |
Intraoral - periapical first radiographic image |
22,788 |
22,242 |
$239K |
| D0274 |
Bitewings - four radiographic images |
10,236 |
10,029 |
$233K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,323 |
4,215 |
$226K |
| D1330 |
|
36,745 |
36,007 |
$222K |
| D0330 |
Panoramic radiographic image |
4,320 |
4,249 |
$188K |
| D0140 |
Limited oral evaluation - problem focused |
4,173 |
4,024 |
$182K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,603 |
1,083 |
$171K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,359 |
6,745 |
$138K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,497 |
2,426 |
$98K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,711 |
12,402 |
$89K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
481 |
370 |
$77K |
| D0273 |
|
2,536 |
2,480 |
$45K |
| D0270 |
|
2,813 |
2,751 |
$26K |
| D7111 |
|
246 |
181 |
$6K |
| D2332 |
|
15 |
12 |
$2K |
| D3120 |
|
12 |
12 |
$420.00 |
| D0603 |
|
457 |
437 |
$0.10 |