| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,427 |
9,709 |
$407K |
| D0120 |
Periodic oral evaluation - established patient |
10,256 |
9,560 |
$324K |
| D1206 |
Topical application of fluoride varnish |
10,903 |
10,164 |
$284K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,294 |
360 |
$233K |
| D1351 |
Sealant - per tooth |
7,033 |
1,229 |
$210K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
939 |
608 |
$102K |
| D0272 |
Bitewings - two radiographic images |
4,323 |
4,031 |
$99K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
882 |
493 |
$74K |
| D0330 |
Panoramic radiographic image |
834 |
800 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
284 |
243 |
$16K |
| D0240 |
|
765 |
373 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
835 |
778 |
$14K |
| D1110 |
Prophylaxis - adult |
211 |
211 |
$10K |
| D0274 |
Bitewings - four radiographic images |
227 |
227 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
46 |
27 |
$3K |
| D9420 |
|
16 |
16 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
27 |
27 |
$1K |
| D1354 |
|
29 |
12 |
$791.06 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$715.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,512 |
1,363 |
$0.00 |