| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
24,709 |
23,781 |
$1.28M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17,120 |
16,168 |
$460K |
| D1208 |
Topical application of fluoride, excluding varnish |
26,460 |
25,400 |
$408K |
| D1110 |
Prophylaxis - adult |
3,711 |
3,538 |
$185K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,888 |
1,689 |
$179K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,416 |
1,587 |
$119K |
| D0272 |
Bitewings - two radiographic images |
6,374 |
6,048 |
$116K |
| D0330 |
Panoramic radiographic image |
2,108 |
2,005 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,216 |
3,166 |
$77K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,125 |
1,922 |
$75K |
| D0274 |
Bitewings - four radiographic images |
1,687 |
1,604 |
$48K |
| D1351 |
Sealant - per tooth |
1,979 |
514 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
367 |
181 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
99 |
32 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,018 |
949 |
$10K |
| D9110 |
|
176 |
160 |
$4K |
| D1206 |
Topical application of fluoride varnish |
242 |
240 |
$4K |