| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,030 |
12,113 |
$342K |
| D0120 |
Periodic oral evaluation - established patient |
12,679 |
11,809 |
$316K |
| D1206 |
Topical application of fluoride varnish |
14,921 |
13,850 |
$231K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,700 |
2,452 |
$117K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,024 |
615 |
$108K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
702 |
272 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,210 |
2,040 |
$94K |
| D0272 |
Bitewings - two radiographic images |
5,218 |
4,851 |
$93K |
| D1351 |
Sealant - per tooth |
3,268 |
930 |
$85K |
| D1110 |
Prophylaxis - adult |
2,068 |
1,922 |
$76K |
| D1354 |
|
5,198 |
1,501 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
457 |
278 |
$33K |
| D0240 |
|
2,080 |
1,337 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,876 |
1,769 |
$28K |
| D0330 |
Panoramic radiographic image |
362 |
335 |
$20K |
| D0274 |
Bitewings - four radiographic images |
363 |
329 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
673 |
317 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
68 |
68 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
42 |
41 |
$2K |
| D1330 |
|
1,100 |
1,051 |
$0.00 |
| D1310 |
|
224 |
198 |
$0.00 |