| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,805 |
11,700 |
$371K |
| D0120 |
Periodic oral evaluation - established patient |
12,232 |
12,113 |
$287K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,678 |
1,399 |
$210K |
| D0272 |
Bitewings - two radiographic images |
7,584 |
7,508 |
$155K |
| D1206 |
Topical application of fluoride varnish |
9,305 |
9,197 |
$154K |
| D1351 |
Sealant - per tooth |
4,557 |
1,451 |
$113K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,672 |
996 |
$99K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,020 |
5,837 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
7,165 |
7,029 |
$79K |
| D0274 |
Bitewings - four radiographic images |
2,367 |
2,349 |
$70K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
556 |
223 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,808 |
3,792 |
$64K |
| D0145 |
Oral evaluation for a patient under three years of age |
346 |
342 |
$47K |
| D1110 |
Prophylaxis - adult |
1,076 |
1,065 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,469 |
1,405 |
$39K |
| D9248 |
|
572 |
546 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
815 |
803 |
$27K |
| D0330 |
Panoramic radiographic image |
517 |
510 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
195 |
192 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
50 |
50 |
$3K |
| D7960 |
|
15 |
12 |
$2K |
| D0603 |
|
6,889 |
6,772 |
$0.00 |