| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,882 |
6,647 |
$387K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,857 |
4,720 |
$146K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,199 |
6,973 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,660 |
977 |
$112K |
| D0330 |
Panoramic radiographic image |
1,618 |
1,557 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
3,290 |
3,168 |
$83K |
| D1110 |
Prophylaxis - adult |
1,218 |
1,190 |
$70K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
576 |
349 |
$66K |
| D7140 |
Extraction, erupted tooth or exposed root |
952 |
584 |
$64K |
| D1351 |
Sealant - per tooth |
2,800 |
719 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,697 |
1,575 |
$61K |
| D0272 |
Bitewings - two radiographic images |
2,832 |
2,745 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
850 |
606 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,051 |
1,022 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
826 |
794 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,463 |
1,414 |
$17K |
| D1206 |
Topical application of fluoride varnish |
746 |
736 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
414 |
300 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
13 |
$2K |
| D9986 |
|
13 |
12 |
$0.00 |