| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,853 |
13,751 |
$572K |
| D0120 |
Periodic oral evaluation - established patient |
15,360 |
15,242 |
$424K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,977 |
17,832 |
$353K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,021 |
1,920 |
$286K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,197 |
1,769 |
$270K |
| D1110 |
Prophylaxis - adult |
4,286 |
4,234 |
$217K |
| D0330 |
Panoramic radiographic image |
3,400 |
3,348 |
$197K |
| D0274 |
Bitewings - four radiographic images |
4,841 |
4,787 |
$151K |
| D1351 |
Sealant - per tooth |
4,318 |
1,243 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,565 |
2,535 |
$106K |
| D0272 |
Bitewings - two radiographic images |
4,825 |
4,779 |
$100K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,099 |
1,094 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,509 |
2,442 |
$33K |
| D1354 |
|
1,793 |
442 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
796 |
766 |
$26K |
| D0240 |
|
1,241 |
736 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
176 |
123 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
965 |
901 |
$7K |
| D1206 |
Topical application of fluoride varnish |
208 |
204 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
525 |
478 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
234 |
234 |
$69.58 |
| D0601 |
|
635 |
632 |
$0.00 |
| D0602 |
|
2,391 |
2,353 |
$0.00 |
| D0603 |
|
107 |
106 |
$0.00 |