| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,170 |
7,150 |
$214K |
| D1206 |
Topical application of fluoride varnish |
8,973 |
8,862 |
$197K |
| D1120 |
Prophylaxis - child |
7,743 |
7,673 |
$184K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,223 |
288 |
$164K |
| D9999 |
Unspecified adjunctive procedure, by report |
4,550 |
4,485 |
$138K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,962 |
1,888 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
4,994 |
4,856 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,154 |
4,126 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,421 |
1,360 |
$32K |
| D1351 |
Sealant - per tooth |
1,453 |
539 |
$30K |
| D9920 |
|
651 |
643 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
244 |
165 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,361 |
1,355 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
639 |
618 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
187 |
82 |
$12K |
| D1999 |
|
1,009 |
946 |
$12K |
| D1354 |
|
3,376 |
1,061 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
150 |
107 |
$9K |
| D0330 |
Panoramic radiographic image |
159 |
158 |
$6K |
| D3120 |
|
191 |
112 |
$0.00 |