| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,435 |
3,710 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,815 |
3,968 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,667 |
2,276 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
691 |
298 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
802 |
359 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,703 |
1,989 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,150 |
912 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,765 |
2,263 |
$19K |
| D1110 |
Prophylaxis - adult |
557 |
521 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
389 |
195 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
888 |
665 |
$16K |
| D0240 |
|
1,231 |
405 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,032 |
849 |
$13K |
| D0330 |
Panoramic radiographic image |
269 |
257 |
$12K |
| D0274 |
Bitewings - four radiographic images |
487 |
446 |
$10K |
| D1351 |
Sealant - per tooth |
512 |
153 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
69 |
12 |
$7K |
| D1206 |
Topical application of fluoride varnish |
213 |
207 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
78 |
77 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
15 |
$1K |
| D1999 |
|
21 |
21 |
$0.00 |