| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,366 |
4,345 |
$180K |
| D0120 |
Periodic oral evaluation - established patient |
3,019 |
3,009 |
$179K |
| D1206 |
Topical application of fluoride varnish |
4,318 |
4,299 |
$68K |
| D1310 |
|
1,337 |
1,328 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
795 |
793 |
$52K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
444 |
118 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,109 |
1,011 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
617 |
362 |
$40K |
| D9993 |
|
651 |
642 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,735 |
2,405 |
$28K |
| D1351 |
Sealant - per tooth |
538 |
180 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,561 |
1,550 |
$18K |
| D0603 |
|
1,126 |
1,116 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
223 |
101 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
191 |
114 |
$10K |
| D9430 |
|
314 |
309 |
$10K |
| D0350 |
|
570 |
291 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
391 |
384 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
69 |
69 |
$4K |
| D0274 |
Bitewings - four radiographic images |
157 |
155 |
$3K |
| D9920 |
|
33 |
33 |
$2K |
| D0601 |
|
65 |
65 |
$971.25 |
| D0240 |
|
27 |
15 |
$270.00 |