| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,728 |
10,627 |
$311K |
| D9920 |
|
5,016 |
4,819 |
$285K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,478 |
15,316 |
$275K |
| D0120 |
Periodic oral evaluation - established patient |
13,706 |
13,561 |
$235K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,485 |
1,486 |
$180K |
| D1110 |
Prophylaxis - adult |
4,300 |
4,238 |
$164K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,864 |
1,234 |
$114K |
| D0272 |
Bitewings - two radiographic images |
4,365 |
4,318 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
8,215 |
8,085 |
$78K |
| D1351 |
Sealant - per tooth |
2,277 |
618 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,314 |
6,919 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
683 |
451 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,327 |
1,199 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
914 |
911 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,001 |
984 |
$18K |
| D9994 |
|
4,433 |
4,357 |
$17K |
| D1354 |
|
1,354 |
374 |
$16K |
| D9310 |
|
147 |
143 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
115 |
111 |
$8K |
| D3120 |
|
559 |
316 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
52 |
51 |
$645.58 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
25 |
$0.00 |
| D0270 |
|
13 |
13 |
$0.00 |