| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,826 |
7,764 |
$262K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,900 |
1,320 |
$256K |
| D1206 |
Topical application of fluoride varnish |
9,776 |
9,691 |
$204K |
| D0120 |
Periodic oral evaluation - established patient |
9,031 |
8,956 |
$182K |
| D1351 |
Sealant - per tooth |
3,195 |
933 |
$107K |
| D0272 |
Bitewings - two radiographic images |
4,584 |
4,525 |
$92K |
| D1110 |
Prophylaxis - adult |
1,815 |
1,792 |
$87K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,068 |
604 |
$73K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,337 |
1,288 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
584 |
373 |
$43K |
| D0330 |
Panoramic radiographic image |
391 |
388 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,364 |
1,343 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
476 |
462 |
$12K |
| D9248 |
|
110 |
108 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
737 |
727 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
71 |
71 |
$5K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
39 |
12 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
67 |
67 |
$2K |
| D9920 |
|
115 |
115 |
$2K |
| D9222 |
|
13 |
13 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
26 |
$523.90 |
| D9630 |
|
26 |
26 |
$468.00 |