| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,526 |
3,519 |
$154K |
| D1351 |
Sealant - per tooth |
6,386 |
1,574 |
$121K |
| D1206 |
Topical application of fluoride varnish |
3,713 |
3,707 |
$114K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,304 |
767 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
2,968 |
2,963 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
870 |
576 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,552 |
1,508 |
$38K |
| D1353 |
|
2,976 |
680 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,804 |
1,801 |
$17K |
| D0603 |
|
2,209 |
2,205 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
220 |
151 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
561 |
560 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
3,065 |
3,055 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,858 |
2,839 |
$8K |
| D0274 |
Bitewings - four radiographic images |
707 |
703 |
$8K |
| D1110 |
Prophylaxis - adult |
233 |
232 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
125 |
125 |
$5K |
| D0601 |
|
450 |
449 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
26 |
15 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$1K |
| D9920 |
|
39 |
39 |
$850.00 |
| D0602 |
|
76 |
76 |
$640.00 |