| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,804 |
4,774 |
$156K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,903 |
6,865 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
6,304 |
6,272 |
$129K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,227 |
853 |
$111K |
| D1110 |
Prophylaxis - adult |
2,180 |
2,171 |
$99K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
638 |
413 |
$85K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,939 |
1,796 |
$68K |
| D0272 |
Bitewings - two radiographic images |
2,059 |
2,059 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
469 |
459 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
444 |
303 |
$29K |
| D1351 |
Sealant - per tooth |
818 |
214 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
664 |
661 |
$22K |
| D9920 |
|
226 |
210 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
311 |
304 |
$9K |
| D0330 |
Panoramic radiographic image |
115 |
112 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
293 |
290 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
190 |
138 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
13 |
$1K |
| D9630 |
|
12 |
12 |
$238.44 |
| D1999 |
|
122 |
111 |
$0.00 |