| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
15,890 |
15,325 |
$634K |
| D0120 |
Periodic oral evaluation - established patient |
15,411 |
14,874 |
$453K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,707 |
1,445 |
$366K |
| D1206 |
Topical application of fluoride varnish |
17,615 |
16,943 |
$365K |
| D0272 |
Bitewings - two radiographic images |
8,631 |
8,249 |
$217K |
| D1310 |
|
5,155 |
4,925 |
$200K |
| D1351 |
Sealant - per tooth |
5,680 |
1,752 |
$180K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,371 |
4,084 |
$149K |
| D0330 |
Panoramic radiographic image |
1,770 |
1,695 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,313 |
823 |
$105K |
| D1110 |
Prophylaxis - adult |
1,345 |
1,326 |
$81K |
| D0274 |
Bitewings - four radiographic images |
1,903 |
1,848 |
$78K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
549 |
156 |
$69K |
| D1330 |
|
2,789 |
2,775 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,499 |
1,414 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
483 |
274 |
$39K |
| D0240 |
|
1,589 |
841 |
$31K |
| D0425 |
|
580 |
559 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
615 |
583 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
565 |
534 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
67 |
67 |
$2K |
| D0603 |
|
99 |
99 |
$1K |
| D1354 |
|
40 |
12 |
$819.62 |
| D0230 |
Intraoral - periapical each additional radiographic image |
31 |
12 |
$373.05 |