| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,963 |
12,964 |
$354K |
| D0120 |
Periodic oral evaluation - established patient |
11,825 |
11,028 |
$285K |
| D1206 |
Topical application of fluoride varnish |
15,627 |
14,430 |
$233K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,405 |
3,201 |
$134K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,118 |
934 |
$114K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
898 |
344 |
$112K |
| D0272 |
Bitewings - two radiographic images |
6,465 |
5,991 |
$104K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,325 |
2,152 |
$99K |
| D0140 |
Limited oral evaluation - problem focused |
3,061 |
2,799 |
$99K |
| D1351 |
Sealant - per tooth |
3,961 |
1,286 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
6,593 |
5,949 |
$91K |
| D1110 |
Prophylaxis - adult |
1,301 |
1,163 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
332 |
244 |
$26K |
| D0330 |
Panoramic radiographic image |
524 |
488 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,085 |
1,248 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
48 |
39 |
$5K |
| D0274 |
Bitewings - four radiographic images |
62 |
56 |
$2K |
| D2140 |
|
21 |
12 |
$2K |
| D1354 |
|
255 |
65 |
$1K |
| D0270 |
|
40 |
38 |
$358.96 |
| D1208 |
Topical application of fluoride, excluding varnish |
18 |
18 |
$282.96 |
| D0145 |
Oral evaluation for a patient under three years of age |
19 |
16 |
$114.03 |
| D9996 |
|
263 |
196 |
$88.00 |
| D9410 |
|
68 |
53 |
$0.00 |