| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,962 |
1,916 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,382 |
2,330 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,545 |
1,354 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
1,342 |
1,321 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
481 |
467 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
316 |
145 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,595 |
1,571 |
$11K |
| D0330 |
Panoramic radiographic image |
196 |
196 |
$4K |
| D0274 |
Bitewings - four radiographic images |
257 |
252 |
$3K |
| D0272 |
Bitewings - two radiographic images |
249 |
245 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
59 |
29 |
$1K |
| D9248 |
|
86 |
85 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
118 |
116 |
$1K |
| D1354 |
|
669 |
120 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
22 |
$1K |
| D1110 |
Prophylaxis - adult |
120 |
120 |
$1K |
| D1351 |
Sealant - per tooth |
237 |
92 |
$718.12 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
64 |
34 |
$628.56 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
59 |
57 |
$566.06 |
| D1999 |
|
228 |
205 |
$97.50 |
| D0145 |
Oral evaluation for a patient under three years of age |
45 |
45 |
$84.24 |