| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
5,710 |
807 |
$130K |
| D1120 |
Prophylaxis - child |
2,194 |
1,988 |
$64K |
| D1206 |
Topical application of fluoride varnish |
2,619 |
2,365 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,674 |
1,498 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,481 |
1,323 |
$35K |
| D9920 |
|
615 |
369 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,007 |
963 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
816 |
612 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,758 |
1,600 |
$21K |
| D0240 |
|
1,235 |
589 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
189 |
89 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
173 |
100 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
361 |
317 |
$10K |
| D0330 |
Panoramic radiographic image |
293 |
266 |
$10K |
| D0274 |
Bitewings - four radiographic images |
341 |
323 |
$10K |
| D0272 |
Bitewings - two radiographic images |
418 |
372 |
$8K |
| D1110 |
Prophylaxis - adult |
176 |
168 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
39 |
14 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
25 |
$3K |
| D1999 |
|
2,255 |
1,693 |
$0.00 |