| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,411 |
10,318 |
$263K |
| D1206 |
Topical application of fluoride varnish |
12,291 |
12,178 |
$193K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,028 |
696 |
$181K |
| D9630 |
|
8,896 |
8,799 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
8,538 |
8,457 |
$125K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,089 |
6,175 |
$96K |
| D1351 |
Sealant - per tooth |
3,876 |
1,099 |
$83K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,728 |
2,592 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,417 |
2,404 |
$63K |
| D1110 |
Prophylaxis - adult |
1,798 |
1,772 |
$61K |
| D0272 |
Bitewings - two radiographic images |
4,070 |
4,038 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
6,824 |
6,731 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
671 |
390 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
874 |
431 |
$37K |
| D0330 |
Panoramic radiographic image |
900 |
897 |
$34K |
| D0274 |
Bitewings - four radiographic images |
984 |
975 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
943 |
925 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
676 |
646 |
$12K |
| D9999 |
Unspecified adjunctive procedure, by report |
33 |
25 |
$4K |
| D9920 |
|
45 |
44 |
$3K |
| D0240 |
|
26 |
13 |
$319.02 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
277 |
170 |
$0.00 |