| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,583 |
9,509 |
$311K |
| D1206 |
Topical application of fluoride varnish |
9,757 |
9,677 |
$197K |
| D0120 |
Periodic oral evaluation - established patient |
8,158 |
8,100 |
$192K |
| D0272 |
Bitewings - two radiographic images |
5,547 |
5,501 |
$89K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
760 |
374 |
$85K |
| D9248 |
|
700 |
657 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
640 |
470 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,124 |
1,115 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,487 |
2,448 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,062 |
1,007 |
$30K |
| D1110 |
Prophylaxis - adult |
662 |
652 |
$27K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,071 |
1,062 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
295 |
204 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
181 |
93 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
888 |
861 |
$8K |
| D1351 |
Sealant - per tooth |
233 |
77 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
241 |
236 |
$5K |
| D1354 |
|
469 |
242 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
58 |
58 |
$1K |
| D1999 |
|
131 |
129 |
$0.00 |