| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,400 |
11,201 |
$396K |
| D0120 |
Periodic oral evaluation - established patient |
9,571 |
9,403 |
$270K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,750 |
559 |
$249K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,905 |
10,710 |
$220K |
| D0272 |
Bitewings - two radiographic images |
5,355 |
5,203 |
$104K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,278 |
668 |
$100K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,432 |
1,409 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
979 |
619 |
$66K |
| D0330 |
Panoramic radiographic image |
565 |
548 |
$31K |
| D1110 |
Prophylaxis - adult |
604 |
595 |
$31K |
| D1206 |
Topical application of fluoride varnish |
861 |
860 |
$27K |
| D1351 |
Sealant - per tooth |
777 |
239 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,968 |
1,879 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
318 |
148 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
477 |
436 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,351 |
1,189 |
$13K |
| D9420 |
|
152 |
115 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
234 |
233 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
346 |
339 |
$5K |
| D9920 |
|
63 |
48 |
$3K |
| D9248 |
|
12 |
12 |
$1K |