| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
15,389 |
14,780 |
$352K |
| D1120 |
Prophylaxis - child |
13,624 |
13,566 |
$343K |
| D0120 |
Periodic oral evaluation - established patient |
11,628 |
11,589 |
$254K |
| D1351 |
Sealant - per tooth |
5,837 |
1,068 |
$148K |
| D1999 |
|
8,115 |
7,980 |
$80K |
| D0272 |
Bitewings - two radiographic images |
6,199 |
6,170 |
$77K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
928 |
910 |
$26K |
| D0145 |
Oral evaluation for a patient under three years of age |
661 |
660 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
299 |
161 |
$22K |
| D1110 |
Prophylaxis - adult |
425 |
425 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
656 |
654 |
$14K |
| D0330 |
Panoramic radiographic image |
346 |
343 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
80 |
51 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
36 |
13 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
508 |
502 |
$3K |
| D0240 |
|
302 |
157 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
62 |
61 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
50 |
50 |
$948.51 |
| D0230 |
Intraoral - periapical each additional radiographic image |
34 |
13 |
$174.90 |