| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,322 |
5,120 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
4,711 |
4,551 |
$29K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
784 |
285 |
$25K |
| D1206 |
Topical application of fluoride varnish |
5,955 |
5,716 |
$25K |
| D0272 |
Bitewings - two radiographic images |
2,786 |
2,658 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,129 |
1,071 |
$9K |
| D1351 |
Sealant - per tooth |
2,156 |
511 |
$8K |
| D0330 |
Panoramic radiographic image |
650 |
614 |
$7K |
| D1110 |
Prophylaxis - adult |
659 |
627 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
682 |
596 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
231 |
93 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
191 |
114 |
$2K |
| D0240 |
|
918 |
398 |
$2K |
| D1354 |
|
189 |
88 |
$2K |
| D0274 |
Bitewings - four radiographic images |
169 |
159 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
36 |
25 |
$788.05 |
| D0220 |
Intraoral - periapical first radiographic image |
163 |
139 |
$505.09 |
| D0145 |
Oral evaluation for a patient under three years of age |
59 |
55 |
$386.62 |
| D0210 |
Intraoral - complete series of radiographic images |
31 |
30 |
$266.16 |
| D0140 |
Limited oral evaluation - problem focused |
25 |
24 |
$251.52 |
| D0602 |
|
147 |
140 |
$0.00 |
| D0603 |
|
229 |
219 |
$0.00 |