| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,080 |
1,986 |
$67K |
| D0145 |
Oral evaluation for a patient under three years of age |
488 |
473 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,186 |
2,083 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,884 |
1,796 |
$49K |
| D1351 |
Sealant - per tooth |
1,896 |
424 |
$47K |
| D0272 |
Bitewings - two radiographic images |
1,301 |
1,238 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,412 |
2,269 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,707 |
1,624 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
471 |
447 |
$15K |
| D1110 |
Prophylaxis - adult |
150 |
144 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
47 |
12 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
282 |
244 |
$7K |
| D1206 |
Topical application of fluoride varnish |
497 |
480 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
77 |
44 |
$7K |
| D0274 |
Bitewings - four radiographic images |
201 |
195 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
67 |
37 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
13 |
$2K |
| D0350 |
|
16 |
16 |
$18.38 |
| D0603 |
|
3,172 |
3,081 |
$0.00 |