| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,061 |
2,962 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
824 |
425 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,913 |
2,775 |
$66K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
525 |
306 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,366 |
1,341 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,061 |
953 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,608 |
1,520 |
$20K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
277 |
76 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
2,343 |
2,183 |
$12K |
| D0330 |
Panoramic radiographic image |
369 |
349 |
$10K |
| D1351 |
Sealant - per tooth |
939 |
247 |
$9K |
| D1110 |
Prophylaxis - adult |
447 |
429 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
668 |
627 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,552 |
1,868 |
$7K |
| D0274 |
Bitewings - four radiographic images |
668 |
612 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
62 |
38 |
$3K |
| D1206 |
Topical application of fluoride varnish |
2,096 |
1,957 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$1K |
| D1330 |
|
2,103 |
1,912 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
46 |
12 |
$0.00 |
| D0350 |
|
1,257 |
1,020 |
$0.00 |
| D1999 |
|
748 |
664 |
$0.00 |
| D1354 |
|
856 |
148 |
$0.00 |