| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,593 |
4,561 |
$209K |
| D0120 |
Periodic oral evaluation - established patient |
2,871 |
2,859 |
$198K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,201 |
1,195 |
$81K |
| D1206 |
Topical application of fluoride varnish |
4,306 |
4,284 |
$77K |
| D1310 |
|
1,795 |
1,789 |
$67K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,127 |
1,065 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
605 |
330 |
$40K |
| D0240 |
|
4,049 |
1,999 |
$39K |
| D1351 |
Sealant - per tooth |
1,208 |
335 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,872 |
1,859 |
$22K |
| D0603 |
|
1,409 |
1,404 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,557 |
1,834 |
$18K |
| D0274 |
Bitewings - four radiographic images |
935 |
931 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
203 |
203 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
35 |
25 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
280 |
278 |
$3K |
| D0602 |
|
187 |
187 |
$3K |
| D9430 |
|
45 |
43 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$1K |
| D9993 |
|
157 |
157 |
$871.50 |
| D0350 |
|
69 |
41 |
$748.80 |
| D1330 |
|
51 |
49 |
$0.00 |