| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
10,541 |
1,843 |
$752K |
| D1120 |
Prophylaxis - child |
4,175 |
3,369 |
$82K |
| D1206 |
Topical application of fluoride varnish |
5,228 |
4,201 |
$70K |
| D1351 |
Sealant - per tooth |
4,223 |
979 |
$68K |
| D0240 |
|
5,923 |
2,151 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,551 |
2,021 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
3,513 |
2,835 |
$47K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
773 |
186 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,047 |
462 |
$36K |
| D1110 |
Prophylaxis - adult |
1,005 |
780 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
1,173 |
850 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,173 |
1,007 |
$19K |
| D0330 |
Panoramic radiographic image |
553 |
484 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
478 |
274 |
$14K |
| D9920 |
|
536 |
470 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
450 |
395 |
$7K |
| D1510 |
|
184 |
128 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
807 |
524 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
919 |
233 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
244 |
177 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
217 |
52 |
$739.57 |
| D1999 |
|
1,500 |
893 |
$0.00 |