| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,081 |
1,046 |
$47K |
| D1351 |
Sealant - per tooth |
2,033 |
320 |
$45K |
| D1206 |
Topical application of fluoride varnish |
1,171 |
1,130 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,871 |
1,077 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
594 |
566 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
459 |
448 |
$12K |
| D9248 |
|
124 |
118 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,138 |
1,093 |
$10K |
| D0330 |
Panoramic radiographic image |
175 |
166 |
$6K |
| D0274 |
Bitewings - four radiographic images |
212 |
201 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
94 |
40 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
38 |
14 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
55 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
88 |
83 |
$2K |
| D0272 |
Bitewings - two radiographic images |
73 |
72 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
12 |
$1K |
| D1353 |
|
79 |
13 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
64 |
63 |
$635.32 |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$600.00 |
| D0603 |
|
483 |
468 |
$442.00 |
| D0602 |
|
84 |
82 |
$78.00 |