| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
20,712 |
17,315 |
$489K |
| D1206 |
Topical application of fluoride varnish |
21,161 |
17,591 |
$428K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,556 |
1,490 |
$410K |
| D0120 |
Periodic oral evaluation - established patient |
13,723 |
12,383 |
$327K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,383 |
5,994 |
$211K |
| D0272 |
Bitewings - two radiographic images |
10,144 |
8,503 |
$133K |
| D0330 |
Panoramic radiographic image |
3,782 |
3,062 |
$104K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,479 |
613 |
$98K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,764 |
2,347 |
$84K |
| D0140 |
Limited oral evaluation - problem focused |
2,318 |
1,959 |
$80K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,436 |
2,190 |
$79K |
| D0210 |
Intraoral - complete series of radiographic images |
1,357 |
922 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,565 |
3,976 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,974 |
1,682 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
1,908 |
1,690 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,868 |
915 |
$14K |
| D9310 |
|
118 |
109 |
$5K |
| D0350 |
|
102 |
94 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12 |
12 |
$1K |
| D1110 |
Prophylaxis - adult |
40 |
32 |
$1K |
| D1354 |
|
514 |
202 |
$0.00 |
| D1999 |
|
4,835 |
4,643 |
$0.00 |
| D3120 |
|
14 |
13 |
$0.00 |
| D9420 |
|
14 |
13 |
$0.00 |