| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
21,048 |
20,845 |
$587K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,604 |
1,308 |
$416K |
| D1206 |
Topical application of fluoride varnish |
23,847 |
23,616 |
$412K |
| D0120 |
Periodic oral evaluation - established patient |
16,935 |
16,775 |
$282K |
| D0272 |
Bitewings - two radiographic images |
6,934 |
6,853 |
$115K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,252 |
3,192 |
$95K |
| D1110 |
Prophylaxis - adult |
1,906 |
1,884 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,579 |
2,543 |
$63K |
| D1351 |
Sealant - per tooth |
3,196 |
949 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
867 |
627 |
$60K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,753 |
2,733 |
$47K |
| D0330 |
Panoramic radiographic image |
966 |
957 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
535 |
260 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
3,126 |
3,072 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,111 |
1,092 |
$23K |
| D0240 |
|
1,535 |
1,269 |
$16K |
| D0274 |
Bitewings - four radiographic images |
666 |
664 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
882 |
423 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
101 |
86 |
$7K |
| D9999 |
Unspecified adjunctive procedure, by report |
13 |
13 |
$2K |
| D9995 |
|
21 |
12 |
$475.00 |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
12 |
$51.36 |
| D9310 |
|
40 |
39 |
$0.00 |
| D9219 |
|
12 |
12 |
$0.00 |