| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,557 |
3,479 |
$115K |
| D1206 |
Topical application of fluoride varnish |
4,028 |
3,936 |
$83K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,169 |
512 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
2,771 |
2,709 |
$64K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
537 |
225 |
$59K |
| D9248 |
|
724 |
651 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,638 |
1,606 |
$47K |
| D0330 |
Panoramic radiographic image |
896 |
877 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,561 |
1,526 |
$26K |
| D1110 |
Prophylaxis - adult |
565 |
552 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
293 |
175 |
$22K |
| D1351 |
Sealant - per tooth |
683 |
226 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,518 |
1,460 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,151 |
860 |
$10K |
| D0274 |
Bitewings - four radiographic images |
289 |
284 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
231 |
211 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
142 |
139 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
13 |
$946.41 |
| D1330 |
|
2,015 |
1,950 |
$0.00 |