| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,419 |
1,352 |
$58K |
| D1206 |
Topical application of fluoride varnish |
1,501 |
1,437 |
$49K |
| D0274 |
Bitewings - four radiographic images |
2,275 |
2,120 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,907 |
3,039 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
1,017 |
907 |
$30K |
| D0330 |
Panoramic radiographic image |
834 |
760 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,369 |
2,195 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
805 |
784 |
$25K |
| D1351 |
Sealant - per tooth |
930 |
222 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
479 |
459 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
219 |
64 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
209 |
183 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
67 |
15 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
44 |
13 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
58 |
58 |
$2K |
| D1110 |
Prophylaxis - adult |
47 |
45 |
$1K |
| D0601 |
|
415 |
400 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
58 |
58 |
$1K |
| D0272 |
Bitewings - two radiographic images |
66 |
65 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
13 |
$820.00 |
| D9310 |
|
73 |
61 |
$246.00 |
| D0602 |
|
16 |
15 |
$55.00 |
| D0350 |
|
23 |
21 |
$0.00 |
| D1999 |
|
31 |
26 |
$0.00 |