| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,582 |
13,387 |
$372K |
| D0120 |
Periodic oral evaluation - established patient |
12,746 |
11,697 |
$311K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,386 |
6,449 |
$308K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,003 |
2,109 |
$293K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,760 |
14,457 |
$246K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,682 |
1,974 |
$200K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,162 |
2,904 |
$131K |
| D0272 |
Bitewings - two radiographic images |
4,850 |
4,436 |
$82K |
| D0220 |
Intraoral - periapical first radiographic image |
5,511 |
4,861 |
$76K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,022 |
670 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,621 |
1,491 |
$57K |
| D0240 |
|
3,292 |
1,611 |
$49K |
| D1351 |
Sealant - per tooth |
1,678 |
522 |
$42K |
| D1110 |
Prophylaxis - adult |
1,117 |
1,015 |
$40K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
238 |
175 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,411 |
767 |
$16K |
| D0170 |
|
495 |
444 |
$14K |
| D0274 |
Bitewings - four radiographic images |
259 |
238 |
$7K |
| D0330 |
Panoramic radiographic image |
40 |
40 |
$2K |
| D1206 |
Topical application of fluoride varnish |
116 |
112 |
$2K |
| D1354 |
|
139 |
56 |
$838.96 |
| D0145 |
Oral evaluation for a patient under three years of age |
18 |
17 |
$38.01 |
| D1310 |
|
517 |
515 |
$0.00 |
| D1330 |
|
154 |
153 |
$0.00 |