| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,347 |
12,093 |
$537K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,295 |
2,261 |
$431K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,787 |
905 |
$402K |
| D1206 |
Topical application of fluoride varnish |
14,399 |
14,103 |
$374K |
| D0120 |
Periodic oral evaluation - established patient |
10,114 |
9,909 |
$318K |
| D0140 |
Limited oral evaluation - problem focused |
3,934 |
3,818 |
$176K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,009 |
1,963 |
$131K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,735 |
3,583 |
$130K |
| D0272 |
Bitewings - two radiographic images |
3,437 |
3,368 |
$104K |
| D0220 |
Intraoral - periapical first radiographic image |
3,383 |
3,256 |
$51K |
| D1351 |
Sealant - per tooth |
1,205 |
439 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
677 |
501 |
$12K |
| D9310 |
|
160 |
159 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
70 |
57 |
$10K |
| D0330 |
Panoramic radiographic image |
167 |
162 |
$9K |
| D0240 |
|
320 |
300 |
$6K |
| D2941 |
|
86 |
40 |
$6K |
| D2940 |
|
98 |
48 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
29 |
29 |
$1K |
| D0603 |
|
121 |
98 |
$0.00 |