| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
28,944 |
27,793 |
$805K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,163 |
3,113 |
$698K |
| D0120 |
Periodic oral evaluation - established patient |
34,740 |
33,353 |
$643K |
| D1208 |
Topical application of fluoride, excluding varnish |
39,353 |
37,659 |
$564K |
| D1999 |
|
23,331 |
21,373 |
$442K |
| D0330 |
Panoramic radiographic image |
6,830 |
6,489 |
$306K |
| D0272 |
Bitewings - two radiographic images |
17,176 |
16,496 |
$294K |
| D1110 |
Prophylaxis - adult |
7,704 |
7,384 |
$278K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,000 |
1,988 |
$227K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,800 |
9,755 |
$224K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,199 |
2,050 |
$194K |
| D1351 |
Sealant - per tooth |
8,091 |
2,233 |
$189K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,247 |
1,926 |
$175K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,736 |
4,455 |
$117K |
| D0274 |
Bitewings - four radiographic images |
5,156 |
4,950 |
$115K |
| D0140 |
Limited oral evaluation - problem focused |
2,336 |
2,162 |
$60K |
| D0240 |
|
3,611 |
1,807 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
3,564 |
3,313 |
$37K |
| D1206 |
Topical application of fluoride varnish |
2,023 |
1,955 |
$29K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,239 |
1,176 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,484 |
697 |
$14K |
| D1354 |
|
93 |
36 |
$2K |