| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,460 |
4,393 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,576 |
626 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
4,004 |
3,939 |
$31K |
| D1206 |
Topical application of fluoride varnish |
3,709 |
3,649 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,513 |
2,613 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,939 |
2,876 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
873 |
855 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,487 |
1,464 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,234 |
1,202 |
$8K |
| D0330 |
Panoramic radiographic image |
327 |
314 |
$6K |
| D1110 |
Prophylaxis - adult |
372 |
364 |
$5K |
| D1351 |
Sealant - per tooth |
506 |
198 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
214 |
119 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
576 |
510 |
$4K |
| D0274 |
Bitewings - four radiographic images |
302 |
299 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
28 |
12 |
$987.75 |
| D0140 |
Limited oral evaluation - problem focused |
66 |
66 |
$611.44 |
| D9248 |
|
14 |
14 |
$298.82 |
| D0602 |
|
93 |
93 |
$0.00 |
| D0603 |
|
641 |
624 |
$0.00 |
| D0601 |
|
174 |
158 |
$0.00 |
| D1999 |
|
556 |
490 |
$0.00 |