| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
35,757 |
35,505 |
$1.17M |
| D0120 |
Periodic oral evaluation - established patient |
41,190 |
40,958 |
$954K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,780 |
6,016 |
$727K |
| D1206 |
Topical application of fluoride varnish |
38,611 |
38,321 |
$699K |
| D0274 |
Bitewings - four radiographic images |
12,828 |
12,775 |
$437K |
| D0272 |
Bitewings - two radiographic images |
19,447 |
19,299 |
$437K |
| D9410 |
|
1,175 |
1,098 |
$430K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,266 |
4,271 |
$406K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,168 |
1,629 |
$367K |
| D1110 |
Prophylaxis - adult |
10,236 |
10,183 |
$336K |
| D1351 |
Sealant - per tooth |
10,279 |
4,652 |
$335K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,148 |
11,339 |
$281K |
| D9630 |
|
7,151 |
7,060 |
$252K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,405 |
2,510 |
$244K |
| D0330 |
Panoramic radiographic image |
4,458 |
4,423 |
$226K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,498 |
5,431 |
$197K |
| D0210 |
Intraoral - complete series of radiographic images |
3,603 |
3,596 |
$156K |
| D0220 |
Intraoral - periapical first radiographic image |
6,678 |
6,571 |
$91K |
| D0140 |
Limited oral evaluation - problem focused |
2,303 |
2,259 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,442 |
2,436 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,857 |
1,226 |
$29K |
| D9420 |
|
41 |
41 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
36 |
$4K |