| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,336 |
2,326 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
1,571 |
1,570 |
$42K |
| D1206 |
Topical application of fluoride varnish |
2,311 |
2,300 |
$41K |
| D8660 |
|
102 |
102 |
$27K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
223 |
68 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,087 |
1,083 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
484 |
481 |
$18K |
| D0603 |
|
1,835 |
1,819 |
$11K |
| D0340 |
|
99 |
99 |
$8K |
| D0240 |
|
505 |
271 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
570 |
559 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
189 |
182 |
$6K |
| D9920 |
|
789 |
781 |
$6K |
| D1351 |
Sealant - per tooth |
181 |
57 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
214 |
207 |
$5K |
| D0330 |
Panoramic radiographic image |
129 |
126 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
26 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
46 |
29 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
191 |
98 |
$1K |
| D1354 |
|
662 |
157 |
$1K |
| D0602 |
|
147 |
147 |
$1K |
| D0601 |
|
86 |
86 |
$576.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$324.00 |
| D1310 |
|
2,264 |
2,261 |
$70.00 |
| D1330 |
|
2,263 |
2,260 |
$40.00 |
| D9986 |
|
123 |
118 |
$0.00 |
| D0350 |
|
18 |
18 |
$0.00 |
| D0470 |
|
80 |
80 |
$0.00 |