| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,291 |
4,211 |
$266K |
| D1120 |
Prophylaxis - child |
6,116 |
6,084 |
$253K |
| D1310 |
|
4,489 |
4,457 |
$204K |
| D1206 |
Topical application of fluoride varnish |
4,818 |
4,789 |
$108K |
| D9993 |
|
1,480 |
1,477 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,252 |
1,246 |
$81K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,046 |
1,041 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,797 |
5,077 |
$58K |
| D0603 |
|
3,798 |
3,776 |
$56K |
| D1351 |
Sealant - per tooth |
1,649 |
406 |
$48K |
| D0272 |
Bitewings - two radiographic images |
3,994 |
3,973 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,966 |
1,957 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
301 |
297 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
95 |
36 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
158 |
55 |
$10K |
| D0330 |
Panoramic radiographic image |
266 |
266 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
407 |
399 |
$5K |
| D0602 |
|
222 |
222 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$918.40 |
| D9248 |
|
14 |
12 |
$455.00 |
| D1999 |
|
415 |
400 |
$35.00 |