| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,075 |
6,868 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
6,900 |
6,720 |
$75K |
| D1206 |
Topical application of fluoride varnish |
8,826 |
8,574 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,224 |
7,593 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
8,346 |
8,061 |
$47K |
| D0272 |
Bitewings - two radiographic images |
4,775 |
4,626 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,113 |
658 |
$37K |
| D1351 |
Sealant - per tooth |
2,876 |
845 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,470 |
1,414 |
$28K |
| D1110 |
Prophylaxis - adult |
1,290 |
1,246 |
$26K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
527 |
238 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,414 |
1,369 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,511 |
1,358 |
$13K |
| D0330 |
Panoramic radiographic image |
611 |
582 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
208 |
119 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
36 |
36 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
72 |
66 |
$923.53 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$860.16 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
13 |
$598.80 |
| D1999 |
|
41 |
39 |
$0.00 |
| D1330 |
|
4,984 |
4,661 |
$0.00 |
| D0603 |
|
53 |
46 |
$0.00 |
| D0602 |
|
34 |
34 |
$0.00 |