| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,821 |
1,796 |
$60K |
| D0145 |
Oral evaluation for a patient under three years of age |
404 |
397 |
$54K |
| D0350 |
|
3,601 |
3,563 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,752 |
1,801 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,413 |
1,391 |
$37K |
| D1351 |
Sealant - per tooth |
1,007 |
182 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,952 |
1,928 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,087 |
2,028 |
$24K |
| D0272 |
Bitewings - two radiographic images |
638 |
628 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
408 |
403 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
115 |
38 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
50 |
13 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
192 |
175 |
$4K |
| D1330 |
|
2,184 |
2,171 |
$2K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$892.92 |
| D1110 |
Prophylaxis - adult |
16 |
16 |
$823.20 |
| D0140 |
Limited oral evaluation - problem focused |
40 |
40 |
$600.96 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$415.32 |
| D0603 |
|
3,488 |
3,431 |
$0.00 |