| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
29,157 |
28,302 |
$812K |
| D0120 |
Periodic oral evaluation - established patient |
37,889 |
36,792 |
$721K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,598 |
1,746 |
$634K |
| D1208 |
Topical application of fluoride, excluding varnish |
34,225 |
33,211 |
$498K |
| D0272 |
Bitewings - two radiographic images |
26,818 |
25,854 |
$468K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,604 |
3,029 |
$414K |
| D1999 |
|
20,458 |
18,437 |
$390K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,522 |
3,979 |
$381K |
| D0330 |
Panoramic radiographic image |
6,414 |
6,204 |
$306K |
| D1110 |
Prophylaxis - adult |
7,903 |
7,665 |
$286K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,749 |
9,962 |
$226K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,173 |
2,185 |
$198K |
| D0140 |
Limited oral evaluation - problem focused |
5,068 |
4,739 |
$139K |
| D1206 |
Topical application of fluoride varnish |
6,270 |
6,107 |
$131K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,411 |
2,336 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
2,053 |
1,308 |
$20K |
| D1354 |
|
437 |
210 |
$10K |
| D2331 |
|
75 |
41 |
$5K |
| D9420 |
|
955 |
733 |
$0.00 |