| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,800 |
6,650 |
$330K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,194 |
10,918 |
$306K |
| D0120 |
Periodic oral evaluation - established patient |
7,073 |
6,935 |
$195K |
| D1351 |
Sealant - per tooth |
4,868 |
1,287 |
$171K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,214 |
504 |
$131K |
| D1110 |
Prophylaxis - adult |
1,980 |
1,930 |
$124K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,336 |
663 |
$121K |
| D0220 |
Intraoral - periapical first radiographic image |
4,489 |
4,298 |
$82K |
| D0272 |
Bitewings - two radiographic images |
2,568 |
2,494 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,559 |
3,945 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,061 |
1,019 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,388 |
1,354 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
1,265 |
1,198 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
645 |
333 |
$52K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
616 |
268 |
$52K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,368 |
2,090 |
$46K |
| D8670 |
Periodic orthodontic treatment visit |
252 |
166 |
$35K |
| D0330 |
Panoramic radiographic image |
380 |
376 |
$31K |
| D9920 |
|
248 |
203 |
$14K |
| D9310 |
|
62 |
52 |
$2K |
| D8660 |
|
39 |
38 |
$1K |
| D1999 |
|
1,270 |
1,111 |
$0.00 |