| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,195 |
8,082 |
$127K |
| D0120 |
Periodic oral evaluation - established patient |
7,574 |
7,442 |
$76K |
| D1206 |
Topical application of fluoride varnish |
9,348 |
9,183 |
$72K |
| D0272 |
Bitewings - two radiographic images |
4,690 |
4,594 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
6,528 |
6,339 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
848 |
358 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,230 |
5,635 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,426 |
1,394 |
$27K |
| D0330 |
Panoramic radiographic image |
1,279 |
1,255 |
$23K |
| D1110 |
Prophylaxis - adult |
995 |
954 |
$17K |
| D1351 |
Sealant - per tooth |
1,590 |
479 |
$16K |
| D0274 |
Bitewings - four radiographic images |
602 |
584 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
613 |
573 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
38 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
91 |
89 |
$1K |
| D0350 |
|
139 |
79 |
$782.47 |
| D1999 |
|
81 |
78 |
$712.80 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$285.57 |
| D0270 |
|
78 |
76 |
$264.63 |
| D1208 |
Topical application of fluoride, excluding varnish |
25 |
25 |
$127.23 |
| D1330 |
|
4,694 |
4,446 |
$12.24 |