| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,262 |
3,139 |
$138K |
| D1206 |
Topical application of fluoride varnish |
3,990 |
3,833 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
2,322 |
2,239 |
$55K |
| D1351 |
Sealant - per tooth |
2,300 |
477 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,077 |
1,034 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,743 |
1,687 |
$30K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
440 |
174 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,147 |
998 |
$15K |
| D9248 |
|
167 |
133 |
$12K |
| D0330 |
Panoramic radiographic image |
305 |
291 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
205 |
92 |
$11K |
| D0274 |
Bitewings - four radiographic images |
458 |
437 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
929 |
746 |
$9K |
| D1110 |
Prophylaxis - adult |
181 |
173 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
93 |
43 |
$5K |
| D9999 |
Unspecified adjunctive procedure, by report |
140 |
140 |
$5K |
| D0999 |
Unspecified diagnostic procedure, by report |
117 |
117 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
64 |
43 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
34 |
$2K |
| D9310 |
|
37 |
37 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
46 |
41 |
$1K |
| D0603 |
|
1,080 |
1,003 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
88 |
78 |
$933.72 |
| D0240 |
|
26 |
25 |
$593.88 |
| D0602 |
|
217 |
213 |
$201.00 |
| D0601 |
|
75 |
75 |
$74.00 |
| D9215 |
|
180 |
163 |
$0.00 |
| D1310 |
|
196 |
195 |
$0.00 |
| D9986 |
|
85 |
85 |
$0.00 |