| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,075 |
5,957 |
$190K |
| D1120 |
Prophylaxis - child |
5,303 |
5,192 |
$169K |
| D1206 |
Topical application of fluoride varnish |
6,484 |
6,348 |
$147K |
| D0272 |
Bitewings - two radiographic images |
2,023 |
1,980 |
$57K |
| D1110 |
Prophylaxis - adult |
989 |
972 |
$54K |
| D1351 |
Sealant - per tooth |
814 |
247 |
$24K |
| D0330 |
Panoramic radiographic image |
142 |
142 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
130 |
98 |
$7K |
| D0274 |
Bitewings - four radiographic images |
143 |
137 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
43 |
17 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
200 |
191 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
143 |
142 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
40 |
29 |
$3K |
| D1352 |
|
22 |
13 |
$866.80 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$642.62 |
| D0145 |
Oral evaluation for a patient under three years of age |
23 |
18 |
$554.73 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$259.87 |