| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,605 |
2,579 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
3,156 |
3,127 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,502 |
3,471 |
$50K |
| D0272 |
Bitewings - two radiographic images |
1,772 |
1,755 |
$40K |
| D1351 |
Sealant - per tooth |
1,218 |
277 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,080 |
993 |
$27K |
| D1110 |
Prophylaxis - adult |
359 |
355 |
$19K |
| D0274 |
Bitewings - four radiographic images |
401 |
396 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
74 |
14 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
844 |
823 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
55 |
55 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
86 |
61 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
70 |
54 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
399 |
226 |
$4K |
| D0330 |
Panoramic radiographic image |
88 |
87 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
44 |
44 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$261.04 |
| D0603 |
|
4,899 |
4,820 |
$0.00 |
| D1310 |
|
19 |
19 |
$0.00 |