| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,646 |
11,490 |
$522K |
| D9248 |
|
1,898 |
1,781 |
$350K |
| D1206 |
Topical application of fluoride varnish |
12,860 |
12,687 |
$323K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,095 |
1,175 |
$273K |
| D1351 |
Sealant - per tooth |
7,665 |
1,757 |
$270K |
| D0120 |
Periodic oral evaluation - established patient |
8,770 |
8,657 |
$266K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,576 |
850 |
$263K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,694 |
915 |
$174K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,957 |
1,930 |
$105K |
| D0240 |
|
4,622 |
4,564 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
585 |
360 |
$72K |
| D0272 |
Bitewings - two radiographic images |
3,857 |
3,809 |
$60K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,455 |
1,425 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
922 |
881 |
$41K |
| D9910 |
|
3,754 |
3,586 |
$38K |
| D1330 |
|
5,727 |
5,672 |
$37K |
| D0330 |
Panoramic radiographic image |
692 |
692 |
$31K |
| D1110 |
Prophylaxis - adult |
476 |
469 |
$30K |
| D3120 |
|
851 |
484 |
$29K |
| D0460 |
|
1,727 |
1,599 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
727 |
687 |
$14K |
| D0274 |
Bitewings - four radiographic images |
510 |
510 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
276 |
272 |
$3K |
| D7510 |
|
12 |
12 |
$576.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
27 |
27 |
$190.24 |