| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
30,217 |
29,862 |
$982K |
| D0120 |
Periodic oral evaluation - established patient |
31,031 |
30,651 |
$731K |
| D1208 |
Topical application of fluoride, excluding varnish |
27,879 |
27,522 |
$577K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,041 |
4,290 |
$468K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,389 |
1,231 |
$353K |
| D0272 |
Bitewings - two radiographic images |
13,834 |
13,653 |
$238K |
| D1351 |
Sealant - per tooth |
7,678 |
2,786 |
$225K |
| D1110 |
Prophylaxis - adult |
4,752 |
4,689 |
$201K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,602 |
2,704 |
$201K |
| D1206 |
Topical application of fluoride varnish |
6,197 |
6,138 |
$125K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,656 |
935 |
$92K |
| D0330 |
Panoramic radiographic image |
1,550 |
1,518 |
$71K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,053 |
2,044 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
826 |
809 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,011 |
963 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,000 |
984 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,000 |
988 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,724 |
1,684 |
$20K |
| D9248 |
|
98 |
98 |
$8K |
| D2331 |
|
80 |
51 |
$5K |
| D2330 |
|
41 |
29 |
$2K |
| D1353 |
|
126 |
76 |
$1K |
| D1354 |
|
38 |
12 |
$192.39 |
| D9420 |
|
98 |
93 |
$0.00 |
| D0190 |
|
34 |
34 |
$0.00 |