| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,409 |
2,404 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
918 |
562 |
$68K |
| D9243 |
|
214 |
207 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,702 |
1,699 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
726 |
416 |
$32K |
| D1351 |
Sealant - per tooth |
501 |
289 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,538 |
2,532 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,090 |
1,090 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,805 |
1,804 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
152 |
96 |
$16K |
| D0240 |
|
924 |
829 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
327 |
244 |
$15K |
| D9239 |
|
195 |
194 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
922 |
917 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,072 |
1,066 |
$7K |
| D0330 |
Panoramic radiographic image |
291 |
291 |
$7K |
| D1110 |
Prophylaxis - adult |
124 |
124 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
50 |
43 |
$4K |
| D9990 |
|
93 |
81 |
$3K |
| D1206 |
Topical application of fluoride varnish |
109 |
109 |
$2K |
| D9310 |
|
48 |
48 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
214 |
212 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
195 |
194 |
$1K |
| D0274 |
Bitewings - four radiographic images |
37 |
37 |
$712.80 |
| D9610 |
|
101 |
100 |
$646.12 |
| D9920 |
|
145 |
141 |
$450.52 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
138 |
133 |
$0.00 |
| D1310 |
|
1,395 |
1,393 |
$0.00 |
| D0603 |
|
1,337 |
1,336 |
$0.00 |
| D1330 |
|
1,399 |
1,397 |
$0.00 |
| D0601 |
|
14 |
14 |
$0.00 |
| D9612 |
|
13 |
13 |
$0.00 |
| D3120 |
|
67 |
58 |
$0.00 |