| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
51,109 |
50,420 |
$2.26M |
| D1206 |
Topical application of fluoride varnish |
55,043 |
54,313 |
$1.37M |
| D0120 |
Periodic oral evaluation - established patient |
42,078 |
41,542 |
$1.26M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,300 |
6,011 |
$1.16M |
| D1351 |
Sealant - per tooth |
28,875 |
6,645 |
$993K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,799 |
2,109 |
$757K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,413 |
8,269 |
$438K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,920 |
2,232 |
$428K |
| D0272 |
Bitewings - two radiographic images |
18,723 |
18,455 |
$289K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,586 |
12,703 |
$251K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,227 |
1,646 |
$221K |
| D0330 |
Panoramic radiographic image |
5,092 |
5,010 |
$218K |
| D1330 |
|
29,049 |
28,639 |
$180K |
| D3120 |
|
3,918 |
1,930 |
$135K |
| D0140 |
Limited oral evaluation - problem focused |
2,987 |
2,934 |
$133K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,750 |
2,708 |
$114K |
| D1110 |
Prophylaxis - adult |
1,579 |
1,556 |
$98K |
| D0240 |
|
4,472 |
4,412 |
$72K |
| D0274 |
Bitewings - four radiographic images |
2,099 |
2,066 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
4,434 |
4,356 |
$44K |
| D2940 |
|
671 |
300 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
496 |
494 |
$15K |
| D9420 |
|
195 |
195 |
$3K |
| D2332 |
|
20 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$2K |
| D1354 |
|
143 |
46 |
$1K |