| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,433 |
7,417 |
$252K |
| D0120 |
Periodic oral evaluation - established patient |
8,052 |
8,035 |
$193K |
| D1206 |
Topical application of fluoride varnish |
8,148 |
8,131 |
$170K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,951 |
1,143 |
$116K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,333 |
786 |
$97K |
| D1351 |
Sealant - per tooth |
2,783 |
828 |
$82K |
| D0272 |
Bitewings - two radiographic images |
3,893 |
3,883 |
$70K |
| D1110 |
Prophylaxis - adult |
1,273 |
1,268 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,649 |
1,632 |
$48K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
389 |
263 |
$43K |
| D0330 |
Panoramic radiographic image |
579 |
579 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
401 |
267 |
$24K |
| D9248 |
|
284 |
281 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,770 |
1,750 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
446 |
445 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
249 |
247 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
324 |
322 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
328 |
289 |
$3K |
| D2330 |
|
18 |
13 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$619.49 |