| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,111 |
5,025 |
$263K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,632 |
4,547 |
$122K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,254 |
6,147 |
$95K |
| D0330 |
Panoramic radiographic image |
1,346 |
1,307 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
1,751 |
1,737 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,082 |
1,030 |
$38K |
| D1110 |
Prophylaxis - adult |
688 |
677 |
$34K |
| D0274 |
Bitewings - four radiographic images |
851 |
838 |
$27K |
| D1351 |
Sealant - per tooth |
1,093 |
296 |
$24K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
191 |
167 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,854 |
684 |
$15K |
| D0272 |
Bitewings - two radiographic images |
756 |
736 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
206 |
134 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
980 |
961 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
144 |
128 |
$9K |
| D1354 |
|
271 |
88 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
26 |
$1K |
| D0603 |
|
60 |
57 |
$0.00 |