| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,423 |
7,201 |
$264K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,847 |
928 |
$239K |
| D0120 |
Periodic oral evaluation - established patient |
9,458 |
9,177 |
$234K |
| D1206 |
Topical application of fluoride varnish |
10,668 |
10,350 |
$220K |
| D1110 |
Prophylaxis - adult |
3,034 |
2,941 |
$145K |
| D1351 |
Sealant - per tooth |
3,639 |
983 |
$130K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
931 |
533 |
$96K |
| D0272 |
Bitewings - two radiographic images |
2,830 |
2,727 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,230 |
2,166 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,734 |
1,604 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
560 |
307 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,316 |
1,269 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,986 |
2,870 |
$39K |
| D8660 |
|
198 |
198 |
$28K |
| D0330 |
Panoramic radiographic image |
407 |
404 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
487 |
472 |
$20K |
| D0340 |
|
199 |
199 |
$12K |
| D0470 |
|
182 |
182 |
$9K |
| D0350 |
|
199 |
198 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
128 |
121 |
$4K |
| D0240 |
|
97 |
95 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
94 |
94 |
$3K |