| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,027 |
3,871 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
4,058 |
3,891 |
$111K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
819 |
304 |
$107K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,142 |
738 |
$95K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,602 |
1,425 |
$58K |
| D1206 |
Topical application of fluoride varnish |
2,324 |
2,222 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,560 |
2,460 |
$51K |
| D0272 |
Bitewings - two radiographic images |
2,134 |
2,031 |
$43K |
| D0145 |
Oral evaluation for a patient under three years of age |
707 |
681 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
508 |
388 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,716 |
1,457 |
$19K |
| D0330 |
Panoramic radiographic image |
342 |
315 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
247 |
135 |
$17K |
| D1110 |
Prophylaxis - adult |
356 |
329 |
$16K |
| D1351 |
Sealant - per tooth |
588 |
188 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
182 |
178 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
499 |
453 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
122 |
87 |
$2K |
| D1354 |
|
130 |
41 |
$2K |
| D9420 |
|
12 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$517.04 |
| D9210 |
|
527 |
477 |
$0.00 |
| D0240 |
|
106 |
55 |
$0.00 |
| D9986 |
|
409 |
366 |
$0.00 |