| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,952 |
7,584 |
$255K |
| D1206 |
Topical application of fluoride varnish |
9,702 |
9,214 |
$192K |
| D0120 |
Periodic oral evaluation - established patient |
4,730 |
4,454 |
$101K |
| D1110 |
Prophylaxis - adult |
1,878 |
1,781 |
$77K |
| D0330 |
Panoramic radiographic image |
1,450 |
1,351 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,986 |
1,771 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,961 |
1,852 |
$51K |
| D1351 |
Sealant - per tooth |
1,700 |
508 |
$51K |
| D0272 |
Bitewings - two radiographic images |
2,130 |
2,039 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,331 |
1,210 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
448 |
309 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
295 |
203 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
154 |
99 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,361 |
1,268 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,590 |
532 |
$14K |
| D9248 |
|
147 |
125 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
139 |
68 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
25 |
$518.28 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$339.43 |
| D1999 |
|
184 |
97 |
$0.00 |