| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
28,854 |
27,685 |
$791K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,051 |
4,618 |
$768K |
| D0120 |
Periodic oral evaluation - established patient |
31,276 |
30,036 |
$582K |
| D1208 |
Topical application of fluoride, excluding varnish |
30,157 |
28,986 |
$426K |
| D0272 |
Bitewings - two radiographic images |
19,133 |
18,195 |
$318K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,836 |
3,046 |
$294K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,992 |
9,260 |
$183K |
| D0330 |
Panoramic radiographic image |
3,267 |
3,181 |
$154K |
| D1999 |
|
8,779 |
8,490 |
$141K |
| D1351 |
Sealant - per tooth |
5,538 |
1,766 |
$121K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,207 |
1,240 |
$107K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,245 |
307 |
$107K |
| D1110 |
Prophylaxis - adult |
2,247 |
2,186 |
$82K |
| D1206 |
Topical application of fluoride varnish |
3,107 |
2,882 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
2,200 |
2,010 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
2,994 |
2,668 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,156 |
1,104 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
856 |
807 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
506 |
457 |
$10K |
| D2335 |
|
23 |
12 |
$2K |
| D1510 |
|
19 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23 |
13 |
$160.00 |
| D9420 |
|
13 |
12 |
$0.00 |