| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
17,220 |
16,791 |
$442K |
| D0120 |
Periodic oral evaluation - established patient |
21,323 |
20,807 |
$385K |
| D1206 |
Topical application of fluoride varnish |
22,015 |
21,469 |
$316K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,469 |
2,572 |
$233K |
| D0272 |
Bitewings - two radiographic images |
11,137 |
10,856 |
$195K |
| D0220 |
Intraoral - periapical first radiographic image |
14,521 |
14,095 |
$158K |
| D1110 |
Prophylaxis - adult |
5,788 |
5,640 |
$148K |
| D1351 |
Sealant - per tooth |
5,259 |
2,156 |
$142K |
| D0274 |
Bitewings - four radiographic images |
4,875 |
4,729 |
$129K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,216 |
5,696 |
$107K |
| D9630 |
|
3,428 |
3,338 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,081 |
10,522 |
$92K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,796 |
1,443 |
$88K |
| D0210 |
Intraoral - complete series of radiographic images |
1,444 |
1,422 |
$65K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
368 |
292 |
$46K |
| D0330 |
Panoramic radiographic image |
1,392 |
1,319 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
629 |
467 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,089 |
1,057 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
271 |
259 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
34 |
24 |
$2K |
| D0270 |
|
155 |
146 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$888.32 |