| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,323 |
6,201 |
$267K |
| D0120 |
Periodic oral evaluation - established patient |
6,606 |
6,474 |
$247K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,971 |
1,175 |
$178K |
| D1206 |
Topical application of fluoride varnish |
3,753 |
3,676 |
$109K |
| D1351 |
Sealant - per tooth |
2,701 |
539 |
$93K |
| D0272 |
Bitewings - two radiographic images |
3,399 |
3,337 |
$86K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,719 |
2,669 |
$68K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,658 |
1,456 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
268 |
204 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,191 |
2,089 |
$20K |
| D0274 |
Bitewings - four radiographic images |
857 |
817 |
$17K |
| D1110 |
Prophylaxis - adult |
393 |
383 |
$17K |
| D0603 |
|
1,986 |
1,938 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,581 |
1,439 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
68 |
39 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
36 |
$5K |
| D0602 |
|
566 |
533 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
58 |
58 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$1K |
| D8660 |
|
21 |
12 |
$0.00 |
| D0330 |
Panoramic radiographic image |
14 |
12 |
$0.00 |
| D8670 |
Periodic orthodontic treatment visit |
498 |
412 |
$0.00 |
| D9310 |
|
43 |
31 |
$0.00 |