| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,094 |
4,862 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,070 |
1,980 |
$60K |
| D1206 |
Topical application of fluoride varnish |
5,831 |
5,546 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
3,808 |
3,630 |
$22K |
| D0603 |
|
1,086 |
1,085 |
$21K |
| D1110 |
Prophylaxis - adult |
642 |
613 |
$19K |
| D0601 |
|
846 |
806 |
$17K |
| D1330 |
|
6,063 |
5,790 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
414 |
238 |
$11K |
| D0330 |
Panoramic radiographic image |
435 |
403 |
$9K |
| D0272 |
Bitewings - two radiographic images |
2,183 |
2,092 |
$7K |
| D1351 |
Sealant - per tooth |
1,079 |
223 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
394 |
360 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,260 |
1,521 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
2,097 |
2,005 |
$4K |
| D0274 |
Bitewings - four radiographic images |
622 |
591 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
82 |
61 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
48 |
25 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
24 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
242 |
223 |
$1K |
| D0602 |
|
222 |
222 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
13 |
$241.86 |