| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,102 |
7,005 |
$212K |
| D0120 |
Periodic oral evaluation - established patient |
7,323 |
7,222 |
$160K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,966 |
6,858 |
$126K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,812 |
1,047 |
$119K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,158 |
346 |
$116K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,798 |
2,609 |
$78K |
| D0272 |
Bitewings - two radiographic images |
3,336 |
3,277 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
897 |
604 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
357 |
201 |
$22K |
| D0330 |
Panoramic radiographic image |
514 |
510 |
$21K |
| D1351 |
Sealant - per tooth |
688 |
258 |
$16K |
| D1206 |
Topical application of fluoride varnish |
815 |
802 |
$14K |
| D1110 |
Prophylaxis - adult |
306 |
294 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,042 |
1,002 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
325 |
321 |
$9K |
| D0274 |
Bitewings - four radiographic images |
257 |
244 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
146 |
145 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
136 |
97 |
$1K |
| D9420 |
|
39 |
39 |
$0.00 |