| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,960 |
6,888 |
$244K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,980 |
1,217 |
$98K |
| D0330 |
Panoramic radiographic image |
1,539 |
1,530 |
$75K |
| D1110 |
Prophylaxis - adult |
1,298 |
1,284 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,522 |
7,452 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
7,341 |
7,263 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
857 |
589 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,486 |
2,171 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
797 |
795 |
$23K |
| D0274 |
Bitewings - four radiographic images |
5,889 |
5,829 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
351 |
236 |
$18K |
| D1351 |
Sealant - per tooth |
2,897 |
981 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,004 |
6,231 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
283 |
231 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
6,626 |
6,535 |
$7K |
| D1330 |
|
8,196 |
8,116 |
$7K |
| D9999 |
Unspecified adjunctive procedure, by report |
361 |
361 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
169 |
167 |
$1K |
| D1206 |
Topical application of fluoride varnish |
438 |
437 |
$216.00 |
| D0272 |
Bitewings - two radiographic images |
865 |
860 |
$22.00 |