| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,387 |
10,872 |
$479K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,681 |
2,310 |
$436K |
| D1206 |
Topical application of fluoride varnish |
16,174 |
15,449 |
$391K |
| D0120 |
Periodic oral evaluation - established patient |
11,138 |
10,612 |
$321K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,999 |
1,939 |
$275K |
| D1110 |
Prophylaxis - adult |
2,456 |
2,355 |
$143K |
| D1351 |
Sealant - per tooth |
4,497 |
1,032 |
$140K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,629 |
1,561 |
$84K |
| D0330 |
Panoramic radiographic image |
1,911 |
1,827 |
$81K |
| D0272 |
Bitewings - two radiographic images |
4,846 |
4,646 |
$73K |
| D0140 |
Limited oral evaluation - problem focused |
1,250 |
1,200 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
5,791 |
5,501 |
$51K |
| D1330 |
|
8,463 |
8,090 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,710 |
1,648 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,657 |
4,425 |
$29K |
| D0240 |
|
251 |
245 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
13 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$520.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
12 |
$242.45 |