| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,366 |
6,307 |
$173K |
| D1120 |
Prophylaxis - child |
5,533 |
5,480 |
$158K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,118 |
668 |
$125K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,962 |
3,923 |
$69K |
| D1110 |
Prophylaxis - adult |
1,394 |
1,383 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,193 |
1,174 |
$54K |
| D1351 |
Sealant - per tooth |
1,690 |
550 |
$50K |
| D1206 |
Topical application of fluoride varnish |
2,710 |
2,690 |
$46K |
| D0272 |
Bitewings - two radiographic images |
2,272 |
2,246 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
392 |
263 |
$33K |
| D0330 |
Panoramic radiographic image |
535 |
530 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,335 |
1,320 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
434 |
427 |
$20K |
| D0274 |
Bitewings - four radiographic images |
389 |
389 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
949 |
927 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
127 |
75 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
29 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
22 |
17 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
39 |
$2K |
| D1354 |
|
36 |
17 |
$305.98 |