| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,526 |
1,522 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,704 |
1,698 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,569 |
1,564 |
$23K |
| D1110 |
Prophylaxis - adult |
318 |
314 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,004 |
1,001 |
$9K |
| D0330 |
Panoramic radiographic image |
182 |
181 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
355 |
349 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
292 |
287 |
$7K |
| D0274 |
Bitewings - four radiographic images |
389 |
386 |
$6K |
| D1351 |
Sealant - per tooth |
284 |
65 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
85 |
72 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
259 |
257 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
517 |
234 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
543 |
531 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
25 |
22 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
37 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
24 |
$2K |
| D0240 |
|
126 |
83 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
65 |
61 |
$0.00 |
| D1330 |
|
28 |
28 |
$0.00 |