| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,115 |
7,796 |
$431K |
| D1206 |
Topical application of fluoride varnish |
8,427 |
8,111 |
$425K |
| D0350 |
|
13,166 |
3,366 |
$204K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,144 |
3,992 |
$127K |
| D0120 |
Periodic oral evaluation - established patient |
3,337 |
3,210 |
$104K |
| D1351 |
Sealant - per tooth |
4,762 |
818 |
$101K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,803 |
1,131 |
$96K |
| D0274 |
Bitewings - four radiographic images |
4,384 |
4,212 |
$95K |
| D0220 |
Intraoral - periapical first radiographic image |
6,125 |
5,885 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,479 |
6,962 |
$48K |
| D0330 |
Panoramic radiographic image |
1,058 |
1,020 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,745 |
1,669 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,582 |
1,481 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
690 |
413 |
$28K |
| D1110 |
Prophylaxis - adult |
492 |
490 |
$23K |
| D0340 |
|
464 |
435 |
$18K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
79 |
52 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
162 |
147 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
193 |
192 |
$4K |
| D7111 |
|
46 |
28 |
$1K |
| D8660 |
|
28 |
27 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
13 |
12 |
$615.42 |
| D9986 |
|
30 |
30 |
$0.00 |