| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,394 |
9,102 |
$293K |
| D0120 |
Periodic oral evaluation - established patient |
9,569 |
9,158 |
$219K |
| D1206 |
Topical application of fluoride varnish |
8,627 |
8,130 |
$166K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,456 |
912 |
$102K |
| D1110 |
Prophylaxis - adult |
2,129 |
2,048 |
$84K |
| D0272 |
Bitewings - two radiographic images |
3,678 |
3,519 |
$63K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,184 |
1,969 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,543 |
1,455 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,095 |
2,074 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
676 |
609 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
545 |
311 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,983 |
1,824 |
$23K |
| D1351 |
Sealant - per tooth |
896 |
233 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
337 |
236 |
$20K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
161 |
68 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
599 |
575 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,151 |
605 |
$10K |
| D0330 |
Panoramic radiographic image |
221 |
218 |
$10K |
| D0274 |
Bitewings - four radiographic images |
201 |
184 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
42 |
41 |
$935.34 |
| D1354 |
|
32 |
13 |
$180.73 |
| D1999 |
|
6,212 |
5,517 |
$0.00 |