| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
19,072 |
18,392 |
$246K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,762 |
4,143 |
$217K |
| D0120 |
Periodic oral evaluation - established patient |
18,735 |
18,132 |
$150K |
| D1206 |
Topical application of fluoride varnish |
16,904 |
16,288 |
$113K |
| D0220 |
Intraoral - periapical first radiographic image |
24,614 |
23,638 |
$109K |
| D0274 |
Bitewings - four radiographic images |
10,068 |
9,741 |
$86K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,905 |
19,470 |
$78K |
| D0272 |
Bitewings - two radiographic images |
9,068 |
8,711 |
$64K |
| D1110 |
Prophylaxis - adult |
4,545 |
4,426 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,116 |
3,981 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,005 |
1,330 |
$53K |
| D0140 |
Limited oral evaluation - problem focused |
3,328 |
3,187 |
$45K |
| D1351 |
Sealant - per tooth |
4,313 |
1,339 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,912 |
6,745 |
$34K |
| D0330 |
Panoramic radiographic image |
2,539 |
2,454 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,037 |
3,425 |
$29K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
182 |
142 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
966 |
562 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
620 |
388 |
$21K |
| D2954 |
|
136 |
112 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
447 |
437 |
$5K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
74 |
37 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
39 |
25 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
167 |
167 |
$1K |
| D2950 |
|
29 |
26 |
$1K |
| D1354 |
|
113 |
40 |
$856.08 |
| D9248 |
|
25 |
24 |
$543.87 |
| D0270 |
|
68 |
66 |
$241.72 |
| D0602 |
|
1,188 |
1,136 |
$0.00 |
| D0601 |
|
352 |
340 |
$0.00 |
| D0603 |
|
6,326 |
6,062 |
$0.00 |