| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,506 |
10,317 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
9,565 |
9,406 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,866 |
9,258 |
$72K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,388 |
1,148 |
$68K |
| D1206 |
Topical application of fluoride varnish |
6,806 |
6,676 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
10,143 |
9,903 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,070 |
2,032 |
$30K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
618 |
182 |
$29K |
| D1351 |
Sealant - per tooth |
2,709 |
894 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,328 |
4,269 |
$22K |
| D0274 |
Bitewings - four radiographic images |
2,356 |
2,298 |
$21K |
| D0272 |
Bitewings - two radiographic images |
2,789 |
2,732 |
$19K |
| D1110 |
Prophylaxis - adult |
951 |
917 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,947 |
1,825 |
$13K |
| D0330 |
Panoramic radiographic image |
980 |
960 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
346 |
174 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
310 |
197 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
138 |
132 |
$2K |
| D1354 |
|
293 |
76 |
$2K |
| D0350 |
|
136 |
38 |
$194.00 |
| D3120 |
|
46 |
24 |
$146.40 |
| D1330 |
|
5,943 |
5,708 |
$0.00 |
| D0602 |
|
63 |
63 |
$0.00 |
| D0603 |
|
44 |
28 |
$0.00 |
| D9310 |
|
14 |
14 |
$0.00 |