| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,494 |
4,462 |
$168K |
| D0120 |
Periodic oral evaluation - established patient |
3,659 |
3,648 |
$97K |
| D1206 |
Topical application of fluoride varnish |
4,206 |
4,179 |
$75K |
| D0272 |
Bitewings - two radiographic images |
2,165 |
2,161 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
617 |
610 |
$22K |
| D0603 |
|
3,716 |
3,712 |
$21K |
| D0240 |
|
893 |
472 |
$14K |
| D9920 |
|
1,857 |
1,812 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
187 |
180 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
92 |
51 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
109 |
67 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
437 |
431 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
194 |
188 |
$5K |
| D0330 |
Panoramic radiographic image |
123 |
123 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
30 |
14 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
390 |
164 |
$3K |
| D1351 |
Sealant - per tooth |
80 |
29 |
$3K |
| D1354 |
|
545 |
154 |
$2K |
| D1999 |
|
1,961 |
1,872 |
$1K |
| D0601 |
|
254 |
251 |
$1K |
| D1110 |
Prophylaxis - adult |
20 |
20 |
$940.00 |
| D0274 |
Bitewings - four radiographic images |
44 |
44 |
$928.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$638.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
15 |
$378.00 |
| D1330 |
|
4,498 |
4,480 |
$210.00 |
| D1320 |
|
28 |
28 |
$160.00 |
| D1310 |
|
4,469 |
4,462 |
$160.00 |
| D0602 |
|
15 |
15 |
$130.00 |