| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
29,487 |
29,064 |
$1.28M |
| D1206 |
Topical application of fluoride varnish |
45,514 |
44,847 |
$1.12M |
| D0120 |
Periodic oral evaluation - established patient |
33,617 |
33,137 |
$993K |
| D1351 |
Sealant - per tooth |
21,816 |
3,860 |
$734K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,982 |
2,752 |
$730K |
| D0140 |
Limited oral evaluation - problem focused |
9,890 |
9,652 |
$429K |
| D1110 |
Prophylaxis - adult |
6,326 |
6,240 |
$383K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,410 |
1,222 |
$229K |
| D9248 |
|
1,221 |
1,176 |
$225K |
| D0272 |
Bitewings - two radiographic images |
13,392 |
13,173 |
$203K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,053 |
625 |
$168K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,829 |
2,789 |
$147K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,323 |
825 |
$145K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
961 |
551 |
$144K |
| D0274 |
Bitewings - four radiographic images |
6,157 |
6,045 |
$138K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,190 |
5,031 |
$94K |
| D0330 |
Panoramic radiographic image |
1,959 |
1,932 |
$85K |
| D3120 |
|
945 |
582 |
$33K |
| D1330 |
|
4,927 |
4,813 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,473 |
1,439 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$144.32 |
| D0240 |
|
14 |
14 |
$126.00 |