| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,332 |
2,235 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
2,330 |
2,221 |
$7K |
| D1206 |
Topical application of fluoride varnish |
1,862 |
1,777 |
$6K |
| D1110 |
Prophylaxis - adult |
501 |
478 |
$4K |
| D0274 |
Bitewings - four radiographic images |
959 |
889 |
$4K |
| D0272 |
Bitewings - two radiographic images |
1,524 |
1,457 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
2,019 |
1,875 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
546 |
347 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
193 |
183 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,586 |
1,650 |
$810.58 |
| D1351 |
Sealant - per tooth |
464 |
133 |
$810.56 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
355 |
346 |
$626.32 |
| D0330 |
Panoramic radiographic image |
280 |
261 |
$428.23 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
307 |
298 |
$152.75 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
16 |
$82.00 |
| D0140 |
Limited oral evaluation - problem focused |
41 |
37 |
$34.44 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,011 |
976 |
$15.00 |
| D0603 |
|
1,095 |
1,081 |
$0.00 |
| D9248 |
|
84 |
79 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
13 |
$0.00 |
| D0602 |
|
22 |
21 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
90 |
59 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
44 |
44 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
33 |
27 |
$0.00 |