| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,452 |
9,965 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
10,494 |
10,004 |
$45K |
| D1206 |
Topical application of fluoride varnish |
14,125 |
13,516 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,398 |
1,575 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
713 |
561 |
$26K |
| D1110 |
Prophylaxis - adult |
3,690 |
3,565 |
$23K |
| D0274 |
Bitewings - four radiographic images |
6,525 |
6,149 |
$20K |
| D0272 |
Bitewings - two radiographic images |
5,631 |
5,348 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
501 |
369 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
6,216 |
5,705 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,501 |
2,441 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,050 |
4,542 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
926 |
894 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
727 |
656 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
189 |
149 |
$3K |
| D0330 |
Panoramic radiographic image |
2,694 |
2,466 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
82 |
55 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
503 |
495 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
24 |
$689.67 |
| D0602 |
|
110 |
109 |
$0.00 |
| D0603 |
|
6,723 |
6,508 |
$0.00 |
| D9248 |
|
63 |
63 |
$0.00 |
| D3120 |
|
15 |
13 |
$0.00 |
| D1351 |
Sealant - per tooth |
1,128 |
369 |
$0.00 |
| D0350 |
|
1,596 |
1,586 |
$0.00 |
| D1354 |
|
1,085 |
263 |
$0.00 |