| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,907 |
3,699 |
$88.88 |
| D0220 |
Intraoral - periapical first radiographic image |
3,228 |
3,050 |
$44.64 |
| D1206 |
Topical application of fluoride varnish |
4,330 |
4,107 |
$44.24 |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,380 |
2,694 |
$36.69 |
| D0120 |
Periodic oral evaluation - established patient |
4,077 |
3,836 |
$29.74 |
| D0272 |
Bitewings - two radiographic images |
2,127 |
2,054 |
$23.90 |
| D1330 |
|
2,126 |
1,853 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
283 |
270 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
470 |
434 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
299 |
138 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
84 |
83 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
127 |
53 |
$0.00 |
| D1351 |
Sealant - per tooth |
971 |
246 |
$0.00 |
| D0350 |
|
721 |
274 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,036 |
946 |
$0.00 |
| D1110 |
Prophylaxis - adult |
732 |
709 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
580 |
542 |
$0.00 |
| D0330 |
Panoramic radiographic image |
491 |
451 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
143 |
75 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
81 |
27 |
$0.00 |
| D1354 |
|
649 |
198 |
$0.00 |
| D1999 |
|
167 |
126 |
$0.00 |