| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,804 |
6,655 |
$216K |
| D0120 |
Periodic oral evaluation - established patient |
7,464 |
7,286 |
$167K |
| D1206 |
Topical application of fluoride varnish |
8,200 |
8,000 |
$161K |
| D1110 |
Prophylaxis - adult |
1,882 |
1,839 |
$76K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,093 |
663 |
$64K |
| D0272 |
Bitewings - two radiographic images |
3,146 |
3,083 |
$54K |
| D0330 |
Panoramic radiographic image |
1,302 |
1,258 |
$52K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,586 |
1,468 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
523 |
306 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,130 |
1,101 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,475 |
2,378 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
393 |
189 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
696 |
682 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,377 |
954 |
$18K |
| D1354 |
|
2,206 |
845 |
$14K |
| D1351 |
Sealant - per tooth |
399 |
134 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
84 |
37 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
113 |
111 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
51 |
50 |
$1K |
| D1999 |
|
626 |
583 |
$0.00 |
| D9986 |
|
891 |
880 |
$0.00 |
| D9987 |
|
1,065 |
1,037 |
$0.00 |