| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,079 |
8,982 |
$309K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,271 |
2,253 |
$305K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,875 |
11,313 |
$261K |
| D0120 |
Periodic oral evaluation - established patient |
9,409 |
9,330 |
$257K |
| D1351 |
Sealant - per tooth |
8,130 |
1,928 |
$201K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,664 |
11,531 |
$158K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,598 |
1,087 |
$142K |
| D0220 |
Intraoral - periapical first radiographic image |
11,997 |
11,819 |
$138K |
| D0272 |
Bitewings - two radiographic images |
6,246 |
6,187 |
$134K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,715 |
1,045 |
$120K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
884 |
278 |
$116K |
| D1110 |
Prophylaxis - adult |
1,421 |
1,409 |
$74K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,610 |
2,396 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,320 |
560 |
$60K |
| D0274 |
Bitewings - four radiographic images |
1,570 |
1,551 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,160 |
1,141 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
140 |
140 |
$9K |
| D9420 |
|
193 |
187 |
$6K |
| D0330 |
Panoramic radiographic image |
398 |
389 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
209 |
208 |
$4K |
| D9310 |
|
174 |
173 |
$2K |
| D1330 |
|
25 |
24 |
$220.50 |
| D0603 |
|
15,447 |
15,220 |
$0.00 |
| D3120 |
|
20 |
14 |
$0.00 |