| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
538 |
514 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
827 |
759 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
452 |
433 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
79 |
65 |
$10K |
| D4341 |
|
31 |
25 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
183 |
156 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
112 |
98 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
297 |
285 |
$8K |
| D0274 |
Bitewings - four radiographic images |
521 |
476 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,117 |
1,041 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
908 |
844 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
297 |
274 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
56 |
39 |
$4K |
| D0330 |
Panoramic radiographic image |
212 |
200 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
147 |
132 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
56 |
53 |
$3K |
| D1110 |
Prophylaxis - adult |
72 |
71 |
$3K |
| D0272 |
Bitewings - two radiographic images |
171 |
170 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
86 |
62 |
$1K |
| D9110 |
|
16 |
16 |
$880.00 |
| D1206 |
Topical application of fluoride varnish |
25 |
21 |
$624.00 |