| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,442 |
1,411 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,710 |
1,684 |
$45K |
| D9239 |
|
215 |
191 |
$31K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
271 |
75 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,156 |
1,147 |
$26K |
| D0272 |
Bitewings - two radiographic images |
894 |
872 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,388 |
1,351 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
595 |
581 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
490 |
442 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
249 |
89 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
118 |
64 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,573 |
1,148 |
$17K |
| D1206 |
Topical application of fluoride varnish |
714 |
686 |
$14K |
| D1110 |
Prophylaxis - adult |
252 |
249 |
$14K |
| D9243 |
|
227 |
179 |
$14K |
| D1351 |
Sealant - per tooth |
366 |
63 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
43 |
22 |
$5K |
| D0350 |
|
256 |
201 |
$4K |
| D2394 |
|
26 |
12 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
88 |
79 |
$3K |
| D9248 |
|
24 |
21 |
$3K |
| D2950 |
|
18 |
12 |
$3K |
| D0274 |
Bitewings - four radiographic images |
54 |
49 |
$2K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$871.00 |
| D1999 |
|
400 |
373 |
$0.00 |