| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,984 |
1,968 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
669 |
665 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,142 |
1,134 |
$23K |
| D1206 |
Topical application of fluoride varnish |
1,910 |
1,897 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
189 |
99 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,376 |
948 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
45 |
25 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
124 |
65 |
$6K |
| D9248 |
|
26 |
24 |
$6K |
| D0240 |
|
1,295 |
785 |
$6K |
| D0272 |
Bitewings - two radiographic images |
704 |
700 |
$4K |
| D1351 |
Sealant - per tooth |
407 |
106 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
270 |
265 |
$4K |
| D9999 |
Unspecified adjunctive procedure, by report |
149 |
149 |
$3K |
| D0602 |
|
1,131 |
1,121 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
254 |
236 |
$3K |
| D1330 |
|
2,042 |
2,028 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
1,182 |
1,150 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
76 |
76 |
$1K |
| D0603 |
|
876 |
871 |
$370.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
14 |
$0.00 |