| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,854 |
12,730 |
$332K |
| D1206 |
Topical application of fluoride varnish |
13,829 |
13,688 |
$223K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,650 |
607 |
$211K |
| D0120 |
Periodic oral evaluation - established patient |
11,471 |
11,353 |
$176K |
| D9630 |
|
7,957 |
7,873 |
$127K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,932 |
790 |
$91K |
| D0272 |
Bitewings - two radiographic images |
4,531 |
4,493 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,570 |
2,548 |
$67K |
| D1351 |
Sealant - per tooth |
2,497 |
797 |
$60K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,085 |
1,953 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
735 |
471 |
$58K |
| D0330 |
Panoramic radiographic image |
554 |
548 |
$24K |
| D0240 |
|
2,324 |
1,286 |
$22K |
| D2929 |
|
63 |
14 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
200 |
139 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
431 |
371 |
$13K |
| D1110 |
Prophylaxis - adult |
369 |
369 |
$11K |
| D9920 |
|
113 |
111 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
705 |
696 |
$5K |
| D9999 |
Unspecified adjunctive procedure, by report |
46 |
46 |
$4K |
| D3120 |
|
253 |
135 |
$3K |
| D1354 |
|
345 |
133 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
83 |
81 |
$2K |
| D9248 |
|
12 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
61 |
61 |
$690.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
152 |
68 |
$310.86 |