| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,219 |
9,875 |
$343K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,101 |
1,135 |
$275K |
| D1206 |
Topical application of fluoride varnish |
12,784 |
12,320 |
$269K |
| D0120 |
Periodic oral evaluation - established patient |
10,650 |
10,301 |
$263K |
| D0272 |
Bitewings - two radiographic images |
7,782 |
7,517 |
$169K |
| D1110 |
Prophylaxis - adult |
2,649 |
2,565 |
$140K |
| D1310 |
|
3,580 |
3,271 |
$134K |
| D0603 |
|
10,883 |
10,530 |
$106K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,327 |
893 |
$98K |
| D0330 |
Panoramic radiographic image |
1,728 |
1,648 |
$95K |
| D9248 |
|
608 |
566 |
$88K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,836 |
2,706 |
$87K |
| D1330 |
|
3,582 |
3,271 |
$84K |
| D0274 |
Bitewings - four radiographic images |
2,386 |
2,306 |
$81K |
| D1351 |
Sealant - per tooth |
1,915 |
580 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
2,646 |
2,494 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,174 |
1,124 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
350 |
192 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,849 |
1,302 |
$21K |
| D0425 |
|
501 |
454 |
$18K |
| D0240 |
|
1,172 |
639 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
444 |
389 |
$13K |
| D0601 |
|
1,357 |
1,303 |
$13K |
| D0602 |
|
423 |
413 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
101 |
98 |
$4K |
| D9310 |
|
52 |
44 |
$2K |