| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,372 |
4,601 |
$127K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,139 |
2,984 |
$124K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
815 |
583 |
$85K |
| D1206 |
Topical application of fluoride varnish |
4,233 |
3,623 |
$80K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
957 |
679 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
3,938 |
2,119 |
$48K |
| D0330 |
Panoramic radiographic image |
1,194 |
1,083 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,644 |
1,354 |
$42K |
| D1351 |
Sealant - per tooth |
1,224 |
376 |
$32K |
| D0272 |
Bitewings - two radiographic images |
2,263 |
1,754 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,320 |
1,028 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,278 |
1,820 |
$20K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
124 |
90 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
193 |
137 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
398 |
368 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
220 |
219 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,532 |
1,354 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
816 |
607 |
$10K |
| D1999 |
|
1,089 |
884 |
$0.00 |