| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
15,991 |
14,662 |
$377K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,055 |
1,747 |
$312K |
| D1999 |
|
15,777 |
14,430 |
$296K |
| D0120 |
Periodic oral evaluation - established patient |
15,028 |
14,212 |
$283K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,992 |
1,947 |
$231K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,297 |
14,839 |
$220K |
| D1110 |
Prophylaxis - adult |
4,195 |
3,837 |
$146K |
| D0330 |
Panoramic radiographic image |
3,040 |
2,783 |
$132K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,040 |
5,320 |
$126K |
| D0272 |
Bitewings - two radiographic images |
7,425 |
6,635 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,741 |
1,235 |
$108K |
| D1351 |
Sealant - per tooth |
5,288 |
1,151 |
$106K |
| D1206 |
Topical application of fluoride varnish |
4,005 |
3,740 |
$98K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,829 |
1,170 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,038 |
3,283 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
3,071 |
2,806 |
$84K |
| D1354 |
|
1,716 |
783 |
$58K |
| D0274 |
Bitewings - four radiographic images |
1,646 |
1,558 |
$38K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,412 |
1,276 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,156 |
1,877 |
$21K |
| D2330 |
|
184 |
90 |
$7K |
| D7961 |
|
45 |
42 |
$6K |
| D7962 |
|
39 |
39 |
$5K |
| D0240 |
|
201 |
179 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
208 |
152 |
$2K |
| D2332 |
|
20 |
12 |
$2K |
| D9430 |
|
84 |
77 |
$0.00 |