| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,666 |
6,503 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
7,584 |
7,425 |
$132K |
| D1206 |
Topical application of fluoride varnish |
5,143 |
5,096 |
$85K |
| D0272 |
Bitewings - two radiographic images |
5,386 |
5,272 |
$63K |
| D1110 |
Prophylaxis - adult |
1,699 |
1,629 |
$57K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
466 |
120 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,960 |
2,829 |
$43K |
| D1351 |
Sealant - per tooth |
1,616 |
436 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
503 |
263 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
699 |
669 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
3,005 |
2,932 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
588 |
560 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,668 |
2,545 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
113 |
97 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
87 |
79 |
$5K |
| D2140 |
|
119 |
91 |
$5K |
| D1310 |
|
174 |
174 |
$2K |
| D1330 |
|
152 |
152 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
18 |
$1K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$680.96 |
| D1999 |
|
19 |
19 |
$0.00 |