| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,377 |
9,148 |
$495K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,107 |
8,901 |
$249K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,099 |
1,259 |
$223K |
| D1206 |
Topical application of fluoride varnish |
11,326 |
9,932 |
$163K |
| D1110 |
Prophylaxis - adult |
3,705 |
3,344 |
$155K |
| D0120 |
Periodic oral evaluation - established patient |
4,380 |
3,980 |
$101K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,411 |
893 |
$89K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,768 |
2,401 |
$88K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
809 |
309 |
$76K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,361 |
872 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,240 |
2,034 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,780 |
1,611 |
$60K |
| D0272 |
Bitewings - two radiographic images |
2,652 |
2,341 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
2,285 |
2,037 |
$20K |
| D1351 |
Sealant - per tooth |
995 |
323 |
$19K |
| D0330 |
Panoramic radiographic image |
537 |
455 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
733 |
716 |
$12K |
| D9248 |
|
63 |
59 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
14 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
33 |
24 |
$2K |
| D2330 |
|
20 |
12 |
$972.40 |