| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,405 |
8,284 |
$262K |
| D0120 |
Periodic oral evaluation - established patient |
9,292 |
9,168 |
$213K |
| D1206 |
Topical application of fluoride varnish |
9,884 |
9,748 |
$182K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,277 |
323 |
$131K |
| D0272 |
Bitewings - two radiographic images |
3,958 |
3,898 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
866 |
546 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
790 |
459 |
$49K |
| D0240 |
|
3,242 |
1,744 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,430 |
2,261 |
$37K |
| D1351 |
Sealant - per tooth |
1,454 |
444 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
613 |
274 |
$32K |
| D0330 |
Panoramic radiographic image |
592 |
580 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
740 |
724 |
$22K |
| D1110 |
Prophylaxis - adult |
409 |
403 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
787 |
770 |
$9K |
| D0274 |
Bitewings - four radiographic images |
225 |
222 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
119 |
116 |
$3K |
| D9420 |
|
88 |
88 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22 |
13 |
$317.74 |
| D1999 |
|
25 |
24 |
$0.00 |