| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,080 |
6,073 |
$177K |
| D0120 |
Periodic oral evaluation - established patient |
6,263 |
5,695 |
$142K |
| D1206 |
Topical application of fluoride varnish |
7,818 |
6,702 |
$118K |
| D0240 |
|
4,783 |
2,976 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,335 |
1,722 |
$76K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,064 |
1,640 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
802 |
346 |
$65K |
| D1110 |
Prophylaxis - adult |
1,495 |
1,319 |
$55K |
| D0272 |
Bitewings - two radiographic images |
3,164 |
2,682 |
$51K |
| D0330 |
Panoramic radiographic image |
483 |
408 |
$23K |
| D1351 |
Sealant - per tooth |
869 |
217 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
270 |
174 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
431 |
367 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,077 |
857 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
660 |
652 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
126 |
105 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
108 |
69 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
65 |
29 |
$8K |
| D2140 |
|
115 |
84 |
$7K |
| D9248 |
|
59 |
55 |
$6K |
| D0274 |
Bitewings - four radiographic images |
174 |
136 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
283 |
213 |
$4K |
| D3120 |
|
28 |
12 |
$0.00 |