| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,843 |
1,778 |
$78K |
| D1206 |
Topical application of fluoride varnish |
1,852 |
1,782 |
$63K |
| D1351 |
Sealant - per tooth |
2,033 |
500 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,553 |
1,502 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,169 |
1,122 |
$19K |
| D9248 |
|
211 |
197 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
344 |
187 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
232 |
222 |
$7K |
| D0330 |
Panoramic radiographic image |
195 |
189 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
177 |
109 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
104 |
62 |
$7K |
| D0274 |
Bitewings - four radiographic images |
278 |
269 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
482 |
452 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
131 |
92 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
108 |
104 |
$3K |
| D0240 |
|
190 |
102 |
$2K |
| D1353 |
|
227 |
105 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
75 |
63 |
$689.64 |
| D0603 |
|
761 |
567 |
$340.00 |
| D0602 |
|
184 |
168 |
$139.00 |
| D0601 |
|
146 |
101 |
$84.00 |
| D9986 |
|
179 |
170 |
$0.00 |