| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,228 |
2,033 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,206 |
2,001 |
$33K |
| D1120 |
Prophylaxis - child |
1,510 |
1,373 |
$30K |
| D1110 |
Prophylaxis - adult |
899 |
814 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,132 |
1,026 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
282 |
123 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
296 |
141 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
494 |
373 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
104 |
82 |
$3K |
| D1351 |
Sealant - per tooth |
70 |
14 |
$2K |
| D0330 |
Panoramic radiographic image |
46 |
42 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
32 |
25 |
$813.93 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
74 |
27 |
$573.58 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
24 |
$263.02 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$224.75 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$0.00 |
| D3120 |
|
15 |
12 |
$0.00 |