| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
28,470 |
28,204 |
$900K |
| D1208 |
Topical application of fluoride, excluding varnish |
31,726 |
31,442 |
$574K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16,458 |
16,292 |
$571K |
| D0274 |
Bitewings - four radiographic images |
15,097 |
14,947 |
$443K |
| D0220 |
Intraoral - periapical first radiographic image |
30,243 |
29,808 |
$342K |
| D0120 |
Periodic oral evaluation - established patient |
14,746 |
14,639 |
$334K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,808 |
3,793 |
$319K |
| D1351 |
Sealant - per tooth |
12,588 |
3,892 |
$296K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,955 |
2,315 |
$264K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,703 |
28,372 |
$260K |
| D0272 |
Bitewings - two radiographic images |
11,587 |
11,510 |
$237K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,717 |
8,349 |
$237K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,185 |
2,468 |
$230K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,478 |
1,098 |
$174K |
| D1110 |
Prophylaxis - adult |
3,367 |
3,353 |
$131K |
| D0330 |
Panoramic radiographic image |
1,698 |
1,681 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
2,001 |
1,949 |
$58K |
| D9110 |
|
668 |
645 |
$36K |
| D2332 |
|
46 |
36 |
$5K |
| D2330 |
|
32 |
24 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
71 |
67 |
$1K |
| D0340 |
|
13 |
13 |
$557.01 |