| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
2,664 |
2,547 |
$72K |
| D1120 |
Prophylaxis - child |
1,877 |
1,793 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,205 |
2,114 |
$62K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
353 |
285 |
$61K |
| D0330 |
Panoramic radiographic image |
600 |
578 |
$45K |
| D1110 |
Prophylaxis - adult |
704 |
684 |
$41K |
| D0272 |
Bitewings - two radiographic images |
1,333 |
1,292 |
$35K |
| D1351 |
Sealant - per tooth |
1,264 |
409 |
$32K |
| D0274 |
Bitewings - four radiographic images |
710 |
691 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
254 |
194 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
766 |
563 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
325 |
308 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
142 |
125 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
390 |
353 |
$14K |
| D2140 |
|
223 |
170 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
834 |
801 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
108 |
80 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
297 |
213 |
$8K |
| D0240 |
|
266 |
169 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
174 |
166 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
32 |
$2K |
| D9996 |
|
29 |
29 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$636.00 |