| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,349 |
3,282 |
$92K |
| D1120 |
Prophylaxis - child |
2,184 |
2,142 |
$74K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
453 |
154 |
$63K |
| D1110 |
Prophylaxis - adult |
1,090 |
1,069 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
503 |
314 |
$46K |
| D0272 |
Bitewings - two radiographic images |
1,926 |
1,879 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,307 |
2,253 |
$32K |
| D9248 |
|
302 |
296 |
$31K |
| D1351 |
Sealant - per tooth |
1,146 |
407 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
892 |
876 |
$29K |
| D0274 |
Bitewings - four radiographic images |
926 |
905 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,238 |
2,161 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,465 |
1,402 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
192 |
137 |
$14K |
| D1206 |
Topical application of fluoride varnish |
863 |
855 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
157 |
88 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
56 |
56 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
635 |
265 |
$6K |
| D0330 |
Panoramic radiographic image |
166 |
160 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
151 |
148 |
$3K |
| D0603 |
|
4,957 |
4,896 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |