| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
17,803 |
17,794 |
$875K |
| D0120 |
Periodic oral evaluation - established patient |
18,834 |
18,828 |
$575K |
| D1351 |
Sealant - per tooth |
7,277 |
2,910 |
$390K |
| D1206 |
Topical application of fluoride varnish |
10,862 |
10,858 |
$373K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,984 |
2,788 |
$361K |
| D1110 |
Prophylaxis - adult |
4,901 |
4,899 |
$277K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,796 |
2,014 |
$178K |
| D0272 |
Bitewings - two radiographic images |
9,818 |
9,813 |
$175K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,843 |
10,837 |
$172K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,241 |
3,239 |
$113K |
| D0274 |
Bitewings - four radiographic images |
3,158 |
3,156 |
$94K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,509 |
1,047 |
$93K |
| D0330 |
Panoramic radiographic image |
1,813 |
1,812 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
3,332 |
3,306 |
$48K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
259 |
209 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,753 |
2,742 |
$26K |
| D9995 |
|
958 |
957 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
89 |
78 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
631 |
623 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
223 |
223 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
191 |
191 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
221 |
210 |
$3K |
| D0602 |
|
774 |
773 |
$0.00 |
| D1330 |
|
9,744 |
9,732 |
$0.00 |
| D0603 |
|
6,155 |
6,149 |
$0.00 |
| D1310 |
|
2,591 |
2,590 |
$0.00 |
| D0601 |
|
2,183 |
2,180 |
$0.00 |
| D1999 |
|
3,675 |
3,426 |
$0.00 |