| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,225 |
2,197 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
2,475 |
2,443 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,472 |
2,438 |
$50K |
| D0272 |
Bitewings - two radiographic images |
1,386 |
1,340 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
343 |
147 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,751 |
1,649 |
$19K |
| D1110 |
Prophylaxis - adult |
310 |
309 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
228 |
227 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,918 |
1,313 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
101 |
26 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
413 |
362 |
$10K |
| D0330 |
Panoramic radiographic image |
155 |
152 |
$9K |
| D9248 |
|
207 |
174 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
113 |
113 |
$4K |
| D1206 |
Topical application of fluoride varnish |
176 |
176 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
70 |
70 |
$3K |
| D1351 |
Sealant - per tooth |
84 |
26 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
14 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
16 |
14 |
$210.00 |