| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
11,760 |
11,639 |
$240K |
| D0120 |
Periodic oral evaluation - established patient |
9,599 |
9,520 |
$220K |
| D1120 |
Prophylaxis - child |
7,600 |
7,535 |
$212K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,987 |
1,454 |
$137K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,197 |
3,026 |
$118K |
| D1110 |
Prophylaxis - adult |
2,736 |
2,723 |
$107K |
| D0272 |
Bitewings - two radiographic images |
4,226 |
4,194 |
$80K |
| D1351 |
Sealant - per tooth |
1,631 |
296 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
675 |
562 |
$36K |
| D1330 |
|
6,832 |
6,816 |
$34K |
| D9920 |
|
830 |
823 |
$34K |
| D0601 |
|
2,787 |
2,786 |
$28K |
| D0330 |
Panoramic radiographic image |
572 |
570 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
427 |
303 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
917 |
915 |
$21K |
| D0603 |
|
1,990 |
1,988 |
$20K |
| D0274 |
Bitewings - four radiographic images |
586 |
585 |
$18K |
| D1310 |
|
3,373 |
3,361 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
155 |
123 |
$16K |
| D0602 |
|
1,249 |
1,245 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
801 |
793 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
88 |
72 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
101 |
73 |
$6K |
| D2140 |
|
66 |
53 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
146 |
146 |
$2K |
| D0240 |
|
45 |
41 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
21 |
20 |
$516.00 |
| D1999 |
|
40 |
40 |
$0.00 |