| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,725 |
16,655 |
$586K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,857 |
3,346 |
$536K |
| D0120 |
Periodic oral evaluation - established patient |
19,153 |
19,085 |
$534K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,995 |
1,494 |
$424K |
| D1351 |
Sealant - per tooth |
16,156 |
3,745 |
$418K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,344 |
2,335 |
$324K |
| D1206 |
Topical application of fluoride varnish |
19,933 |
19,847 |
$283K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,579 |
14,940 |
$247K |
| D0272 |
Bitewings - two radiographic images |
9,998 |
9,948 |
$225K |
| D0220 |
Intraoral - periapical first radiographic image |
18,266 |
17,989 |
$218K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,858 |
2,036 |
$210K |
| D1110 |
Prophylaxis - adult |
3,949 |
3,934 |
$204K |
| D9248 |
|
1,558 |
1,527 |
$175K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,565 |
5,425 |
$141K |
| D0274 |
Bitewings - four radiographic images |
2,641 |
2,628 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,006 |
1,990 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
925 |
521 |
$48K |
| D1330 |
|
2,653 |
2,620 |
$28K |
| D2331 |
|
250 |
190 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
637 |
623 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
95 |
83 |
$9K |
| D1510 |
|
15 |
13 |
$2K |
| D7111 |
|
135 |
92 |
$1K |
| D0270 |
|
177 |
177 |
$856.03 |
| D1208 |
Topical application of fluoride, excluding varnish |
52 |
52 |
$764.40 |
| D0603 |
|
24,445 |
24,310 |
$0.00 |