| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,890 |
1,888 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,631 |
2,627 |
$65K |
| D1206 |
Topical application of fluoride varnish |
2,073 |
2,070 |
$46K |
| D1110 |
Prophylaxis - adult |
907 |
907 |
$40K |
| D1351 |
Sealant - per tooth |
1,269 |
291 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,455 |
1,451 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
452 |
434 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
261 |
197 |
$19K |
| D0274 |
Bitewings - four radiographic images |
524 |
524 |
$18K |
| D0603 |
|
1,453 |
1,453 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
618 |
618 |
$13K |
| D1330 |
|
2,269 |
2,265 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
161 |
129 |
$10K |
| D0240 |
|
435 |
334 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
97 |
65 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
94 |
94 |
$5K |
| D0602 |
|
528 |
526 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
194 |
194 |
$5K |
| D0330 |
Panoramic radiographic image |
113 |
113 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
387 |
384 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
249 |
222 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
17 |
13 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
27 |
16 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
41 |
41 |
$736.66 |
| D1999 |
|
118 |
117 |
$0.30 |