| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,885 |
10,822 |
$454K |
| D0120 |
Periodic oral evaluation - established patient |
11,005 |
10,005 |
$320K |
| D1206 |
Topical application of fluoride varnish |
11,674 |
10,604 |
$279K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,094 |
1,938 |
$272K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,535 |
1,654 |
$189K |
| D0274 |
Bitewings - four radiographic images |
1,868 |
1,735 |
$77K |
| D0272 |
Bitewings - two radiographic images |
2,483 |
2,286 |
$67K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
367 |
85 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,167 |
962 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
1,305 |
1,213 |
$55K |
| D0330 |
Panoramic radiographic image |
466 |
441 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
504 |
452 |
$27K |
| D9243 |
|
121 |
73 |
$26K |
| D1351 |
Sealant - per tooth |
622 |
203 |
$21K |
| D7240 |
Removal of impacted tooth - completely bony |
143 |
24 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,257 |
1,146 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
166 |
95 |
$16K |
| D9420 |
|
143 |
132 |
$12K |
| D9310 |
|
480 |
314 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
594 |
346 |
$9K |
| D9239 |
|
120 |
74 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
57 |
45 |
$7K |