| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
15,409 |
14,961 |
$445K |
| D0120 |
Periodic oral evaluation - established patient |
16,805 |
16,332 |
$340K |
| D1206 |
Topical application of fluoride varnish |
18,442 |
17,904 |
$311K |
| D1351 |
Sealant - per tooth |
7,383 |
1,396 |
$159K |
| D1110 |
Prophylaxis - adult |
3,407 |
3,286 |
$133K |
| D0272 |
Bitewings - two radiographic images |
5,963 |
5,791 |
$111K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,096 |
378 |
$107K |
| D0274 |
Bitewings - four radiographic images |
1,508 |
1,445 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,433 |
1,382 |
$40K |
| D0330 |
Panoramic radiographic image |
497 |
482 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,906 |
1,811 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
727 |
694 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
92 |
52 |
$5K |
| D0240 |
|
323 |
302 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
125 |
122 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
188 |
80 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
12 |
$1K |
| D1999 |
|
330 |
320 |
$0.00 |