| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,532 |
14,346 |
$478K |
| D8670 |
Periodic orthodontic treatment visit |
1,077 |
1,063 |
$434K |
| D1206 |
Topical application of fluoride varnish |
18,328 |
18,077 |
$375K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,923 |
2,196 |
$341K |
| D0120 |
Periodic oral evaluation - established patient |
15,049 |
14,843 |
$298K |
| D1110 |
Prophylaxis - adult |
3,456 |
3,389 |
$160K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,130 |
3,909 |
$137K |
| D1351 |
Sealant - per tooth |
4,224 |
1,338 |
$134K |
| D0272 |
Bitewings - two radiographic images |
6,238 |
6,149 |
$124K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,670 |
1,153 |
$121K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
766 |
483 |
$103K |
| D9920 |
|
975 |
945 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
942 |
582 |
$62K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
61 |
61 |
$59K |
| D8660 |
|
270 |
258 |
$51K |
| D9994 |
|
5,329 |
5,192 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,484 |
1,440 |
$41K |
| D0330 |
Panoramic radiographic image |
627 |
620 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
965 |
948 |
$30K |
| D0240 |
|
2,146 |
1,158 |
$26K |
| D9248 |
|
232 |
219 |
$26K |
| D0145 |
Oral evaluation for a patient under three years of age |
977 |
963 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,271 |
1,238 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
462 |
447 |
$11K |
| D9310 |
|
53 |
53 |
$4K |
| D0340 |
|
12 |
12 |
$864.24 |