| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,099 |
3,075 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
3,783 |
3,740 |
$89K |
| D1351 |
Sealant - per tooth |
2,651 |
625 |
$77K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,364 |
1,335 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,526 |
2,473 |
$49K |
| D0272 |
Bitewings - two radiographic images |
2,595 |
2,579 |
$48K |
| D1110 |
Prophylaxis - adult |
1,180 |
1,162 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
711 |
549 |
$47K |
| D1206 |
Topical application of fluoride varnish |
1,732 |
1,715 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
538 |
351 |
$35K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
226 |
185 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
439 |
359 |
$24K |
| D0603 |
|
2,392 |
2,384 |
$24K |
| D0330 |
Panoramic radiographic image |
483 |
472 |
$20K |
| D1330 |
|
2,910 |
2,900 |
$17K |
| D0274 |
Bitewings - four radiographic images |
457 |
452 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
372 |
371 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
116 |
82 |
$8K |
| D0240 |
|
408 |
300 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
639 |
633 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
434 |
421 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
114 |
113 |
$2K |
| D1354 |
|
71 |
60 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
57 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$817.00 |
| D9920 |
|
12 |
12 |
$432.00 |
| D0601 |
|
17 |
17 |
$170.00 |
| D0602 |
|
16 |
16 |
$160.00 |