| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,410 |
2,346 |
$68K |
| D1351 |
Sealant - per tooth |
2,502 |
682 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,297 |
1,286 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
408 |
278 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,112 |
1,097 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
1,040 |
950 |
$24K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
181 |
105 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
311 |
213 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
790 |
688 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,166 |
1,152 |
$19K |
| D0272 |
Bitewings - two radiographic images |
867 |
853 |
$15K |
| D0330 |
Panoramic radiographic image |
339 |
336 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
874 |
840 |
$10K |
| D0274 |
Bitewings - four radiographic images |
374 |
371 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
589 |
569 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
29 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
44 |
42 |
$2K |
| D1999 |
|
329 |
314 |
$0.00 |