| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,899 |
4,697 |
$206K |
| D1206 |
Topical application of fluoride varnish |
4,947 |
4,744 |
$160K |
| D9248 |
|
1,398 |
1,249 |
$116K |
| D1351 |
Sealant - per tooth |
4,506 |
1,161 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
3,711 |
3,595 |
$91K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,581 |
959 |
$77K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
769 |
489 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,250 |
768 |
$47K |
| D0272 |
Bitewings - two radiographic images |
2,401 |
2,276 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
830 |
606 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,009 |
957 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,927 |
2,587 |
$28K |
| D0330 |
Panoramic radiographic image |
641 |
625 |
$23K |
| D0240 |
|
937 |
760 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
363 |
341 |
$11K |
| D0999 |
Unspecified diagnostic procedure, by report |
236 |
236 |
$7K |
| D9999 |
Unspecified adjunctive procedure, by report |
259 |
258 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
552 |
522 |
$5K |
| D0274 |
Bitewings - four radiographic images |
217 |
215 |
$5K |
| D0603 |
|
1,376 |
1,136 |
$2K |
| D1353 |
|
166 |
82 |
$2K |
| D0602 |
|
598 |
517 |
$470.25 |
| D3120 |
|
29 |
24 |
$435.20 |
| D0230 |
Intraoral - periapical each additional radiographic image |
62 |
53 |
$347.51 |
| D0601 |
|
154 |
123 |
$135.25 |
| D1999 |
|
5,705 |
4,918 |
$0.00 |