| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
17,618 |
16,401 |
$436K |
| D1120 |
Prophylaxis - child |
13,788 |
12,704 |
$350K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,440 |
735 |
$308K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,175 |
1,922 |
$307K |
| D1206 |
Topical application of fluoride varnish |
16,235 |
15,239 |
$254K |
| D1110 |
Prophylaxis - adult |
5,760 |
5,335 |
$207K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,336 |
1,481 |
$178K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,178 |
3,715 |
$170K |
| D1351 |
Sealant - per tooth |
4,429 |
1,244 |
$113K |
| D0272 |
Bitewings - two radiographic images |
6,171 |
5,649 |
$105K |
| D0330 |
Panoramic radiographic image |
1,723 |
1,538 |
$87K |
| D0274 |
Bitewings - four radiographic images |
2,825 |
2,599 |
$84K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,234 |
566 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,112 |
981 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,817 |
1,500 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
440 |
417 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,120 |
989 |
$15K |
| D0240 |
|
903 |
533 |
$13K |
| D9420 |
|
76 |
64 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
66 |
38 |
$792.25 |
| D3120 |
|
129 |
84 |
$0.00 |