| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,939 |
11,689 |
$312K |
| D0120 |
Periodic oral evaluation - established patient |
11,588 |
11,369 |
$200K |
| D1206 |
Topical application of fluoride varnish |
12,624 |
12,352 |
$163K |
| D0272 |
Bitewings - two radiographic images |
6,260 |
6,110 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,339 |
486 |
$68K |
| D0240 |
|
1,717 |
1,084 |
$18K |
| D1999 |
|
3,817 |
3,671 |
$15K |
| D1110 |
Prophylaxis - adult |
458 |
451 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
182 |
50 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
678 |
653 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
421 |
392 |
$11K |
| D0330 |
Panoramic radiographic image |
274 |
272 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
236 |
230 |
$6K |
| D1351 |
Sealant - per tooth |
274 |
65 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
56 |
56 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
110 |
108 |
$943.27 |
| D0145 |
Oral evaluation for a patient under three years of age |
16 |
16 |
$431.44 |
| D0603 |
|
165 |
161 |
$0.00 |
| D0601 |
|
72 |
71 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |