| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,136 |
4,128 |
$181K |
| D1351 |
Sealant - per tooth |
7,313 |
1,801 |
$150K |
| D1206 |
Topical application of fluoride varnish |
4,317 |
4,308 |
$134K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,540 |
895 |
$120K |
| D0120 |
Periodic oral evaluation - established patient |
3,817 |
3,810 |
$104K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,496 |
1,474 |
$37K |
| D0272 |
Bitewings - two radiographic images |
2,220 |
2,214 |
$32K |
| D1353 |
|
3,595 |
817 |
$31K |
| D0603 |
|
2,059 |
2,054 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
3,169 |
3,162 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
96 |
65 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
182 |
116 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
186 |
149 |
$11K |
| D0274 |
Bitewings - four radiographic images |
803 |
799 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,875 |
2,867 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
106 |
103 |
$4K |
| D1110 |
Prophylaxis - adult |
79 |
79 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
130 |
129 |
$3K |
| D0601 |
|
270 |
270 |
$2K |
| D9920 |
|
67 |
64 |
$2K |
| D0602 |
|
16 |
16 |
$140.00 |