| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,262 |
3,220 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,818 |
2,784 |
$45K |
| D1206 |
Topical application of fluoride varnish |
3,600 |
3,550 |
$40K |
| D1351 |
Sealant - per tooth |
1,543 |
482 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,896 |
1,856 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
417 |
222 |
$9K |
| D0240 |
|
675 |
355 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,927 |
1,842 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
369 |
366 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
489 |
454 |
$6K |
| D0330 |
Panoramic radiographic image |
154 |
151 |
$5K |
| D0603 |
|
803 |
798 |
$5K |
| D1354 |
|
842 |
271 |
$4K |
| D1110 |
Prophylaxis - adult |
311 |
308 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
64 |
40 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
59 |
25 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
102 |
96 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,714 |
1,463 |
$3K |
| D0601 |
|
504 |
501 |
$3K |
| D9630 |
|
37 |
37 |
$1K |
| D0274 |
Bitewings - four radiographic images |
308 |
305 |
$824.00 |
| D1330 |
|
1,445 |
1,442 |
$619.00 |
| D9920 |
|
515 |
510 |
$420.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
61 |
42 |
$112.00 |
| D1310 |
|
1,415 |
1,412 |
$10.00 |
| D0210 |
Intraoral - complete series of radiographic images |
154 |
151 |
$0.00 |
| D1320 |
|
24 |
24 |
$0.00 |
| D9248 |
|
18 |
13 |
$0.00 |
| D1999 |
|
633 |
604 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
113 |
109 |
$0.00 |