| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,165 |
2,949 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
4,206 |
3,919 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,100 |
3,794 |
$63K |
| D1110 |
Prophylaxis - adult |
1,484 |
1,366 |
$52K |
| D0272 |
Bitewings - two radiographic images |
1,415 |
1,290 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,046 |
1,862 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,182 |
1,574 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
535 |
462 |
$11K |
| D0274 |
Bitewings - four radiographic images |
433 |
401 |
$9K |
| D0240 |
|
1,003 |
475 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
466 |
431 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
32 |
13 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
59 |
53 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
143 |
137 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
12 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
48 |
26 |
$0.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$0.00 |