| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,262 |
5,147 |
$232K |
| D1206 |
Topical application of fluoride varnish |
5,301 |
5,172 |
$183K |
| D1351 |
Sealant - per tooth |
3,728 |
946 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,450 |
2,399 |
$79K |
| D0272 |
Bitewings - two radiographic images |
3,140 |
3,055 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,799 |
1,738 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,635 |
1,840 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,577 |
1,526 |
$18K |
| D9248 |
|
200 |
182 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
287 |
149 |
$15K |
| D0330 |
Panoramic radiographic image |
431 |
417 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
180 |
69 |
$12K |
| D0274 |
Bitewings - four radiographic images |
549 |
525 |
$12K |
| D1354 |
|
956 |
264 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
532 |
526 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
251 |
142 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
283 |
280 |
$9K |
| D0603 |
|
1,714 |
1,687 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
427 |
387 |
$8K |
| D0999 |
Unspecified diagnostic procedure, by report |
167 |
167 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
140 |
139 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
42 |
27 |
$2K |
| D0602 |
|
51 |
46 |
$171.20 |
| D0601 |
|
15 |
14 |
$50.20 |