| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,372 |
10,252 |
$363K |
| D0120 |
Periodic oral evaluation - established patient |
14,331 |
14,175 |
$348K |
| D1206 |
Topical application of fluoride varnish |
14,163 |
13,999 |
$284K |
| D1110 |
Prophylaxis - adult |
5,402 |
5,348 |
$257K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,396 |
783 |
$174K |
| D1351 |
Sealant - per tooth |
2,744 |
756 |
$98K |
| D0272 |
Bitewings - two radiographic images |
2,765 |
2,730 |
$58K |
| D0274 |
Bitewings - four radiographic images |
1,570 |
1,555 |
$47K |
| D0330 |
Panoramic radiographic image |
836 |
836 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
339 |
204 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
842 |
827 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
293 |
191 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,845 |
1,803 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
726 |
674 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
516 |
509 |
$21K |
| D8660 |
|
146 |
146 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
304 |
304 |
$11K |
| D8670 |
Periodic orthodontic treatment visit |
81 |
72 |
$10K |
| D0340 |
|
151 |
150 |
$9K |
| D0470 |
|
133 |
133 |
$6K |
| D0350 |
|
136 |
136 |
$4K |