| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,696 |
4,498 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
3,781 |
3,643 |
$82K |
| D1206 |
Topical application of fluoride varnish |
4,178 |
4,005 |
$74K |
| D0272 |
Bitewings - two radiographic images |
2,653 |
2,532 |
$54K |
| D1351 |
Sealant - per tooth |
1,921 |
388 |
$49K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,398 |
1,179 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,144 |
1,067 |
$30K |
| D0240 |
|
1,268 |
695 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
732 |
691 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,606 |
1,533 |
$20K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
137 |
40 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
159 |
102 |
$12K |
| D1110 |
Prophylaxis - adult |
189 |
187 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
111 |
69 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
252 |
230 |
$7K |
| D0330 |
Panoramic radiographic image |
119 |
109 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
66 |
37 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
112 |
111 |
$3K |
| D0274 |
Bitewings - four radiographic images |
86 |
83 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
28 |
27 |
$505.96 |
| D1330 |
|
3,536 |
3,368 |
$0.00 |
| D1999 |
|
2,885 |
2,561 |
$0.00 |