| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,138 |
12,117 |
$409K |
| D0120 |
Periodic oral evaluation - established patient |
12,627 |
12,602 |
$301K |
| D1206 |
Topical application of fluoride varnish |
14,347 |
14,313 |
$277K |
| D0272 |
Bitewings - two radiographic images |
5,582 |
5,575 |
$116K |
| D1110 |
Prophylaxis - adult |
2,535 |
2,526 |
$114K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
399 |
197 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,397 |
1,348 |
$43K |
| D0330 |
Panoramic radiographic image |
735 |
735 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,849 |
2,831 |
$36K |
| D0145 |
Oral evaluation for a patient under three years of age |
723 |
721 |
$23K |
| D1351 |
Sealant - per tooth |
517 |
138 |
$17K |
| D0274 |
Bitewings - four radiographic images |
538 |
535 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
714 |
712 |
$12K |
| D0240 |
|
282 |
282 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
52 |
25 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
91 |
91 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
12 |
$3K |
| D9248 |
|
14 |
14 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$690.82 |