| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,106 |
3,987 |
$159K |
| D0120 |
Periodic oral evaluation - established patient |
3,224 |
3,162 |
$95K |
| D1206 |
Topical application of fluoride varnish |
4,071 |
3,862 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
741 |
391 |
$52K |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
82 |
81 |
$52K |
| D0272 |
Bitewings - two radiographic images |
1,702 |
1,643 |
$32K |
| D1351 |
Sealant - per tooth |
758 |
274 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
580 |
557 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
212 |
101 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
808 |
727 |
$22K |
| D0603 |
|
4,265 |
4,099 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,347 |
1,238 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
572 |
567 |
$11K |
| D1110 |
Prophylaxis - adult |
194 |
192 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
817 |
584 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
90 |
66 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
70 |
36 |
$6K |
| D0330 |
Panoramic radiographic image |
92 |
89 |
$4K |
| D1330 |
|
4,952 |
4,756 |
$4K |
| D9248 |
|
26 |
26 |
$4K |
| D1354 |
|
575 |
197 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
83 |
82 |
$3K |
| D1999 |
|
2,073 |
1,888 |
$3K |
| D0274 |
Bitewings - four radiographic images |
78 |
78 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
43 |
42 |
$1K |
| D0602 |
|
260 |
243 |
$334.00 |