| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,259 |
4,548 |
$102K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
949 |
597 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,062 |
2,037 |
$81K |
| D1206 |
Topical application of fluoride varnish |
3,443 |
3,213 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,060 |
1,024 |
$36K |
| D0330 |
Panoramic radiographic image |
857 |
847 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
2,445 |
1,879 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,980 |
1,794 |
$24K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
127 |
74 |
$16K |
| D9248 |
|
315 |
307 |
$16K |
| D0274 |
Bitewings - four radiographic images |
811 |
772 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
174 |
107 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
165 |
122 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
184 |
184 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
347 |
343 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
919 |
911 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,372 |
1,110 |
$10K |
| D1351 |
Sealant - per tooth |
254 |
66 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
584 |
551 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
102 |
102 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$2K |
| D0603 |
|
2,647 |
2,129 |
$0.00 |