| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
15,996 |
15,641 |
$656K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,060 |
2,690 |
$576K |
| D1206 |
Topical application of fluoride varnish |
17,715 |
17,323 |
$460K |
| D0120 |
Periodic oral evaluation - established patient |
12,773 |
12,495 |
$358K |
| D1351 |
Sealant - per tooth |
5,927 |
2,740 |
$357K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,435 |
1,372 |
$139K |
| D1354 |
|
3,550 |
2,453 |
$79K |
| D0272 |
Bitewings - two radiographic images |
7,465 |
7,264 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,860 |
2,794 |
$65K |
| D0330 |
Panoramic radiographic image |
1,892 |
1,844 |
$44K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,583 |
1,381 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
4,456 |
4,259 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
281 |
180 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,570 |
1,318 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
227 |
226 |
$4K |
| D0274 |
Bitewings - four radiographic images |
230 |
225 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
132 |
131 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
42 |
$2K |
| D0603 |
|
968 |
933 |
$0.00 |
| D9420 |
|
219 |
206 |
$0.00 |