| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,773 |
5,718 |
$146K |
| D0120 |
Periodic oral evaluation - established patient |
3,937 |
3,885 |
$106K |
| D1206 |
Topical application of fluoride varnish |
6,010 |
5,920 |
$105K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,037 |
611 |
$56K |
| D1351 |
Sealant - per tooth |
2,275 |
474 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,584 |
1,488 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
947 |
935 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
451 |
314 |
$19K |
| D0272 |
Bitewings - two radiographic images |
2,031 |
1,996 |
$14K |
| D0274 |
Bitewings - four radiographic images |
1,255 |
1,236 |
$13K |
| D0603 |
|
1,062 |
1,052 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,768 |
1,724 |
$7K |
| D0602 |
|
649 |
643 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,665 |
1,361 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
150 |
100 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
187 |
185 |
$5K |
| D9920 |
|
106 |
100 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
83 |
83 |
$2K |
| D1110 |
Prophylaxis - adult |
136 |
134 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
24 |
13 |
$2K |
| D0273 |
|
199 |
198 |
$2K |
| D0240 |
|
351 |
133 |
$1K |
| D1354 |
|
309 |
125 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
16 |
$877.00 |
| D0601 |
|
61 |
59 |
$590.00 |
| D0270 |
|
42 |
42 |
$126.00 |