| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,756 |
13,517 |
$374K |
| D0120 |
Periodic oral evaluation - established patient |
13,134 |
11,973 |
$229K |
| D1206 |
Topical application of fluoride varnish |
16,137 |
14,801 |
$209K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,621 |
1,308 |
$156K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,312 |
9,538 |
$139K |
| D0220 |
Intraoral - periapical first radiographic image |
13,749 |
12,304 |
$120K |
| D0272 |
Bitewings - two radiographic images |
5,570 |
5,108 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,460 |
2,391 |
$67K |
| D0274 |
Bitewings - four radiographic images |
3,227 |
2,998 |
$61K |
| D1110 |
Prophylaxis - adult |
1,588 |
1,505 |
$49K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
540 |
108 |
$44K |
| D1351 |
Sealant - per tooth |
3,100 |
943 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
611 |
595 |
$27K |
| D0330 |
Panoramic radiographic image |
712 |
671 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,782 |
1,496 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
596 |
592 |
$11K |
| D0240 |
|
1,204 |
647 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
242 |
157 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
76 |
36 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
132 |
125 |
$2K |
| D0160 |
|
41 |
40 |
$2K |
| D1354 |
|
136 |
39 |
$688.55 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$331.30 |
| D1999 |
|
162 |
153 |
$216.60 |
| D0603 |
|
177 |
177 |
$0.00 |
| D0602 |
|
602 |
585 |
$0.00 |
| D0601 |
|
99 |
99 |
$0.00 |