| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,900 |
12,651 |
$199K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,665 |
2,416 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
14,283 |
14,002 |
$142K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,280 |
1,415 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,682 |
8,564 |
$60K |
| D0272 |
Bitewings - two radiographic images |
7,014 |
6,869 |
$58K |
| D1110 |
Prophylaxis - adult |
3,542 |
3,454 |
$56K |
| D1206 |
Topical application of fluoride varnish |
7,139 |
6,950 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
10,135 |
9,863 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,991 |
8,691 |
$50K |
| D1351 |
Sealant - per tooth |
4,680 |
1,451 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,185 |
2,133 |
$33K |
| D0274 |
Bitewings - four radiographic images |
2,857 |
2,791 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
863 |
439 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,253 |
2,090 |
$22K |
| D1999 |
|
8,356 |
7,350 |
$19K |
| D0330 |
Panoramic radiographic image |
855 |
841 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
124 |
55 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
89 |
64 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
246 |
239 |
$3K |
| D1354 |
|
103 |
38 |
$928.52 |
| D0603 |
|
3,581 |
3,452 |
$0.00 |
| D0602 |
|
2,223 |
2,115 |
$0.00 |
| D0601 |
|
205 |
204 |
$0.00 |