| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
3,020 |
1,533 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
514 |
228 |
$14K |
| D1120 |
Prophylaxis - child |
1,008 |
1,002 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,715 |
1,699 |
$10K |
| D1206 |
Topical application of fluoride varnish |
1,363 |
1,361 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
1,077 |
1,076 |
$9K |
| D9248 |
|
207 |
203 |
$5K |
| D0274 |
Bitewings - four radiographic images |
369 |
365 |
$3K |
| D0272 |
Bitewings - two radiographic images |
332 |
331 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
196 |
194 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
98 |
98 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
40 |
12 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
45 |
$1K |
| D1110 |
Prophylaxis - adult |
186 |
186 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
31 |
29 |
$510.77 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
145 |
138 |
$443.88 |
| D1351 |
Sealant - per tooth |
37 |
12 |
$162.18 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$118.85 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
13 |
$0.00 |