| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,519 |
4,425 |
$145K |
| D1206 |
Topical application of fluoride varnish |
5,623 |
5,492 |
$104K |
| D0274 |
Bitewings - four radiographic images |
2,925 |
2,845 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
3,999 |
3,916 |
$91K |
| D1351 |
Sealant - per tooth |
2,082 |
290 |
$50K |
| D1110 |
Prophylaxis - adult |
886 |
871 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,058 |
849 |
$31K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
238 |
88 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
587 |
571 |
$18K |
| D0330 |
Panoramic radiographic image |
586 |
565 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
215 |
108 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
191 |
76 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,329 |
486 |
$13K |
| D0272 |
Bitewings - two radiographic images |
604 |
593 |
$13K |
| D0240 |
|
757 |
400 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
899 |
816 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
170 |
95 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
267 |
263 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
201 |
186 |
$6K |
| D1354 |
|
107 |
28 |
$2K |
| D1330 |
|
33 |
33 |
$0.00 |