| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,593 |
6,035 |
$153K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,282 |
802 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,152 |
3,046 |
$100K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,526 |
1,008 |
$98K |
| D1351 |
Sealant - per tooth |
4,393 |
1,282 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
3,648 |
3,153 |
$78K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
633 |
377 |
$65K |
| D0330 |
Panoramic radiographic image |
1,447 |
1,291 |
$55K |
| D1206 |
Topical application of fluoride varnish |
2,831 |
2,709 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,678 |
3,341 |
$48K |
| D0272 |
Bitewings - two radiographic images |
2,476 |
2,235 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,512 |
1,394 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,940 |
1,495 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,557 |
2,309 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
591 |
527 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,951 |
1,720 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
101 |
101 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
88 |
50 |
$4K |
| D1999 |
|
1,291 |
1,169 |
$0.00 |