| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,351 |
1,346 |
$50K |
| D1206 |
Topical application of fluoride varnish |
1,498 |
1,491 |
$44K |
| D1120 |
Prophylaxis - child |
1,529 |
1,522 |
$42K |
| D1351 |
Sealant - per tooth |
1,148 |
237 |
$34K |
| D9999 |
Unspecified adjunctive procedure, by report |
772 |
766 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
195 |
114 |
$18K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
70 |
37 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
256 |
254 |
$13K |
| D0272 |
Bitewings - two radiographic images |
708 |
705 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
126 |
53 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
228 |
218 |
$6K |
| D0240 |
|
561 |
290 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
558 |
552 |
$5K |
| D0330 |
Panoramic radiographic image |
103 |
103 |
$4K |
| D1354 |
|
759 |
232 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
15 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
686 |
420 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
60 |
57 |
$2K |
| D0603 |
|
37 |
37 |
$370.00 |