| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
844 |
830 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,038 |
1,023 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,192 |
1,175 |
$17K |
| D9248 |
|
142 |
139 |
$15K |
| D1110 |
Prophylaxis - adult |
253 |
249 |
$13K |
| D1351 |
Sealant - per tooth |
386 |
139 |
$10K |
| D0272 |
Bitewings - two radiographic images |
392 |
387 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
120 |
114 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
80 |
54 |
$8K |
| D0240 |
|
750 |
376 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
148 |
140 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
142 |
128 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
13 |
$1K |
| D0274 |
Bitewings - four radiographic images |
26 |
26 |
$899.86 |
| D0602 |
|
725 |
715 |
$0.00 |
| D0603 |
|
538 |
525 |
$0.00 |