| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,081 |
2,930 |
$121K |
| D1206 |
Topical application of fluoride varnish |
3,066 |
2,919 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
2,246 |
2,157 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,474 |
1,296 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
643 |
476 |
$41K |
| D1351 |
Sealant - per tooth |
269 |
178 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,043 |
1,482 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
274 |
224 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
709 |
659 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,017 |
1,867 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
101 |
81 |
$10K |
| D0330 |
Panoramic radiographic image |
228 |
203 |
$5K |
| D9310 |
|
280 |
262 |
$4K |
| D1354 |
|
78 |
60 |
$3K |
| D0272 |
Bitewings - two radiographic images |
295 |
277 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
166 |
153 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
15 |
$709.55 |
| D1999 |
|
115 |
106 |
$0.00 |