| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
17,797 |
8,225 |
$195K |
| D0120 |
Periodic oral evaluation - established patient |
8,187 |
7,862 |
$186K |
| D1120 |
Prophylaxis - child |
5,585 |
5,347 |
$181K |
| D0274 |
Bitewings - four radiographic images |
5,724 |
5,482 |
$170K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,142 |
7,803 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,822 |
1,111 |
$140K |
| D1110 |
Prophylaxis - adult |
2,743 |
2,645 |
$121K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,463 |
959 |
$109K |
| D0220 |
Intraoral - periapical first radiographic image |
8,849 |
8,462 |
$103K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,695 |
2,413 |
$84K |
| D1351 |
Sealant - per tooth |
1,423 |
239 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
489 |
326 |
$38K |
| D0330 |
Panoramic radiographic image |
839 |
825 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
716 |
688 |
$22K |
| D1206 |
Topical application of fluoride varnish |
971 |
942 |
$18K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
140 |
68 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
71 |
68 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
57 |
57 |
$2K |