| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,018 |
6,945 |
$196K |
| D1206 |
Topical application of fluoride varnish |
7,751 |
7,667 |
$134K |
| D0120 |
Periodic oral evaluation - established patient |
5,961 |
5,907 |
$95K |
| D1351 |
Sealant - per tooth |
1,567 |
406 |
$50K |
| D0272 |
Bitewings - two radiographic images |
2,503 |
2,467 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,262 |
1,240 |
$39K |
| D1110 |
Prophylaxis - adult |
581 |
571 |
$21K |
| D0330 |
Panoramic radiographic image |
368 |
365 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
494 |
474 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
100 |
52 |
$6K |
| D0274 |
Bitewings - four radiographic images |
220 |
217 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
171 |
166 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
218 |
216 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
27 |
13 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
272 |
269 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
12 |
$3K |
| D9630 |
|
100 |
98 |
$2K |
| D9920 |
|
97 |
97 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
26 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$270.27 |
| D0240 |
|
14 |
13 |
$171.78 |