| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,264 |
6,147 |
$252K |
| D0120 |
Periodic oral evaluation - established patient |
7,175 |
7,058 |
$215K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,860 |
1,432 |
$185K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,887 |
6,767 |
$128K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,777 |
1,048 |
$104K |
| D0272 |
Bitewings - two radiographic images |
3,580 |
3,522 |
$79K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,589 |
2,326 |
$62K |
| D1110 |
Prophylaxis - adult |
1,178 |
1,163 |
$59K |
| D1351 |
Sealant - per tooth |
1,964 |
655 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
4,151 |
4,071 |
$56K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
420 |
167 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,744 |
3,522 |
$38K |
| D0603 |
|
4,828 |
4,741 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
580 |
568 |
$22K |
| D0330 |
Panoramic radiographic image |
248 |
243 |
$13K |
| D0602 |
|
1,776 |
1,750 |
$11K |
| D3240 |
|
55 |
26 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
25 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
116 |
110 |
$4K |
| D0274 |
Bitewings - four radiographic images |
111 |
110 |
$3K |
| D1206 |
Topical application of fluoride varnish |
170 |
167 |
$3K |
| D2940 |
|
45 |
37 |
$2K |
| D0240 |
|
93 |
49 |
$2K |
| D0601 |
|
66 |
66 |
$460.92 |
| D1310 |
|
1,840 |
1,815 |
$110.00 |
| D1330 |
|
187 |
181 |
$0.00 |