| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,019 |
6,898 |
$193K |
| D1120 |
Prophylaxis - child |
5,090 |
5,003 |
$176K |
| D1206 |
Topical application of fluoride varnish |
7,383 |
7,275 |
$103K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
451 |
130 |
$63K |
| D1110 |
Prophylaxis - adult |
1,002 |
990 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
3,854 |
3,711 |
$41K |
| D0272 |
Bitewings - two radiographic images |
1,720 |
1,684 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,171 |
1,464 |
$36K |
| D1351 |
Sealant - per tooth |
872 |
265 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
115 |
112 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
592 |
551 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
135 |
48 |
$7K |
| D0274 |
Bitewings - four radiographic images |
230 |
228 |
$7K |
| D9248 |
|
44 |
39 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
116 |
113 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
49 |
36 |
$4K |
| D0330 |
Panoramic radiographic image |
95 |
91 |
$3K |
| D8670 |
Periodic orthodontic treatment visit |
52 |
26 |
$400.44 |
| D0603 |
|
8,439 |
8,338 |
$0.00 |
| D0602 |
|
68 |
66 |
$0.00 |