| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,627 |
12,875 |
$438K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,757 |
1,831 |
$369K |
| D1206 |
Topical application of fluoride varnish |
12,771 |
10,933 |
$277K |
| D0120 |
Periodic oral evaluation - established patient |
13,948 |
12,253 |
$273K |
| D1351 |
Sealant - per tooth |
10,412 |
1,859 |
$254K |
| D1110 |
Prophylaxis - adult |
2,775 |
2,402 |
$114K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,695 |
1,340 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,170 |
2,795 |
$100K |
| D0272 |
Bitewings - two radiographic images |
5,380 |
4,748 |
$100K |
| D0210 |
Intraoral - complete series of radiographic images |
1,126 |
977 |
$61K |
| D2140 |
|
1,298 |
922 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,473 |
4,171 |
$55K |
| D0330 |
Panoramic radiographic image |
1,512 |
1,265 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,220 |
1,056 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
387 |
261 |
$27K |
| D0274 |
Bitewings - four radiographic images |
958 |
817 |
$24K |
| D1354 |
|
42 |
14 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
124 |
119 |
$4K |
| D1510 |
|
18 |
12 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
28 |
$2K |
| D0240 |
|
118 |
90 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
12 |
$2K |
| D7111 |
|
22 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
17 |
13 |
$218.75 |