| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,295 |
5,602 |
$182K |
| D0120 |
Periodic oral evaluation - established patient |
7,069 |
6,122 |
$156K |
| D1351 |
Sealant - per tooth |
6,747 |
1,293 |
$151K |
| D1206 |
Topical application of fluoride varnish |
7,924 |
7,055 |
$92K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
922 |
567 |
$80K |
| D0145 |
Oral evaluation for a patient under three years of age |
756 |
657 |
$78K |
| D0272 |
Bitewings - two radiographic images |
3,531 |
3,196 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
869 |
537 |
$61K |
| D1110 |
Prophylaxis - adult |
1,455 |
1,308 |
$60K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,838 |
1,634 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
4,003 |
3,641 |
$38K |
| D0330 |
Panoramic radiographic image |
1,245 |
1,119 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,088 |
3,150 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,028 |
945 |
$27K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
199 |
104 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
883 |
787 |
$23K |
| D9248 |
|
75 |
71 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
40 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
54 |
$938.62 |
| D1208 |
Topical application of fluoride, excluding varnish |
31 |
20 |
$264.60 |
| D0270 |
|
33 |
29 |
$132.30 |
| D3120 |
|
95 |
67 |
$86.01 |
| D0603 |
|
6,972 |
6,655 |
$0.00 |
| D0601 |
|
638 |
616 |
$0.00 |
| D0602 |
|
964 |
877 |
$0.00 |