| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,941 |
6,833 |
$34K |
| D1206 |
Topical application of fluoride varnish |
7,844 |
7,715 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
6,526 |
6,429 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,157 |
5,644 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
923 |
475 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
5,975 |
5,853 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
871 |
858 |
$7K |
| D0274 |
Bitewings - four radiographic images |
1,843 |
1,789 |
$6K |
| D0272 |
Bitewings - two radiographic images |
1,830 |
1,807 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,067 |
1,017 |
$4K |
| D0330 |
Panoramic radiographic image |
595 |
580 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
192 |
119 |
$3K |
| D1351 |
Sealant - per tooth |
620 |
190 |
$3K |
| D1110 |
Prophylaxis - adult |
584 |
565 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
21 |
12 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
13 |
$322.32 |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
17 |
$189.75 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$101.29 |
| D1330 |
|
2,751 |
2,629 |
$0.00 |
| D0603 |
|
77 |
69 |
$0.00 |
| D1999 |
|
218 |
214 |
$0.00 |