| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,055 |
10,820 |
$457K |
| D0120 |
Periodic oral evaluation - established patient |
11,536 |
11,202 |
$325K |
| D1206 |
Topical application of fluoride varnish |
10,917 |
10,700 |
$286K |
| D1351 |
Sealant - per tooth |
2,351 |
1,191 |
$147K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,598 |
2,398 |
$130K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,348 |
1,061 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
936 |
758 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,870 |
1,808 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
950 |
801 |
$39K |
| D0330 |
Panoramic radiographic image |
1,514 |
1,485 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
1,140 |
1,092 |
$27K |
| D0272 |
Bitewings - two radiographic images |
2,400 |
2,338 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,381 |
1,371 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
967 |
934 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
181 |
149 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
128 |
98 |
$15K |
| D1354 |
|
482 |
283 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,927 |
1,865 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
403 |
390 |
$3K |
| D0270 |
|
28 |
27 |
$156.80 |
| D0601 |
|
4,085 |
4,034 |
$0.00 |
| D0602 |
|
2,349 |
2,311 |
$0.00 |
| D0603 |
|
2,101 |
2,048 |
$0.00 |