| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,214 |
9,011 |
$229K |
| D1120 |
Prophylaxis - child |
6,219 |
6,069 |
$179K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,612 |
1,108 |
$166K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,781 |
3,436 |
$148K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,544 |
7,359 |
$123K |
| D1110 |
Prophylaxis - adult |
2,921 |
2,858 |
$122K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
960 |
720 |
$77K |
| D1351 |
Sealant - per tooth |
1,896 |
624 |
$51K |
| D0272 |
Bitewings - two radiographic images |
2,680 |
2,605 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
361 |
203 |
$31K |
| D0274 |
Bitewings - four radiographic images |
945 |
920 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,171 |
1,153 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,049 |
986 |
$14K |
| D0330 |
Panoramic radiographic image |
303 |
295 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
108 |
37 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
229 |
218 |
$8K |
| D0240 |
|
408 |
203 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
123 |
121 |
$5K |
| D9420 |
|
13 |
13 |
$1K |
| D1999 |
|
253 |
224 |
$0.00 |