| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,829 |
2,765 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
2,645 |
2,588 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,213 |
3,138 |
$73K |
| D0272 |
Bitewings - two radiographic images |
2,022 |
1,978 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
2,183 |
2,084 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
558 |
540 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,071 |
1,951 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
363 |
342 |
$13K |
| D1351 |
Sealant - per tooth |
327 |
101 |
$11K |
| D1110 |
Prophylaxis - adult |
98 |
98 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
23 |
13 |
$6K |
| D0240 |
|
145 |
97 |
$5K |
| D0274 |
Bitewings - four radiographic images |
64 |
64 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
44 |
44 |
$1K |
| D1330 |
|
24 |
24 |
$0.00 |