| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,758 |
6,674 |
$140K |
| D1120 |
Prophylaxis - child |
6,598 |
6,516 |
$128K |
| D1206 |
Topical application of fluoride varnish |
3,482 |
3,447 |
$68K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,517 |
451 |
$59K |
| D0272 |
Bitewings - two radiographic images |
3,173 |
3,134 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,141 |
4,082 |
$49K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,347 |
1,314 |
$14K |
| D2140 |
|
71 |
51 |
$3K |
| D1351 |
Sealant - per tooth |
142 |
39 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
302 |
301 |
$1K |
| D1110 |
Prophylaxis - adult |
27 |
27 |
$1K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$926.31 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
181 |
181 |
$597.36 |
| D0230 |
Intraoral - periapical each additional radiographic image |
153 |
140 |
$165.10 |
| D9985 |
|
2,894 |
2,724 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
110 |
51 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
167 |
71 |
$0.00 |
| D1330 |
|
117 |
117 |
$0.00 |
| D3230 |
|
31 |
12 |
$0.00 |
| D1999 |
|
12 |
12 |
$0.00 |
| D2934 |
|
44 |
13 |
$0.00 |