| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,258 |
12,116 |
$327K |
| D0120 |
Periodic oral evaluation - established patient |
13,758 |
13,614 |
$219K |
| D1206 |
Topical application of fluoride varnish |
11,521 |
11,385 |
$195K |
| D1110 |
Prophylaxis - adult |
3,154 |
3,125 |
$112K |
| D0272 |
Bitewings - two radiographic images |
5,761 |
5,704 |
$96K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,284 |
2,205 |
$58K |
| D9994 |
|
6,813 |
6,616 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,889 |
1,872 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,067 |
3,054 |
$45K |
| D1351 |
Sealant - per tooth |
1,264 |
390 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,684 |
2,629 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
555 |
403 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
281 |
214 |
$13K |
| D9630 |
|
698 |
671 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
274 |
274 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,151 |
979 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
26 |
12 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
165 |
100 |
$3K |
| D0274 |
Bitewings - four radiographic images |
295 |
290 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
186 |
185 |
$2K |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$1K |
| D1355 |
|
36 |
13 |
$1K |
| D9992 |
|
235 |
230 |
$927.36 |
| D9990 |
|
64 |
64 |
$922.50 |
| D0240 |
|
70 |
36 |
$269.94 |
| D7962 |
|
12 |
12 |
$0.00 |
| D1354 |
|
26 |
16 |
$0.00 |