| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,824 |
8,231 |
$377K |
| D0120 |
Periodic oral evaluation - established patient |
6,432 |
6,059 |
$137K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,539 |
7,121 |
$103K |
| D0272 |
Bitewings - two radiographic images |
4,885 |
4,546 |
$80K |
| D0330 |
Panoramic radiographic image |
1,735 |
1,609 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,525 |
2,307 |
$58K |
| D7140 |
Extraction, erupted tooth or exposed root |
919 |
395 |
$43K |
| D1351 |
Sealant - per tooth |
2,765 |
778 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
784 |
547 |
$39K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
346 |
88 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,133 |
1,028 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
658 |
572 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,316 |
1,136 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
489 |
454 |
$11K |
| D1354 |
|
1,569 |
726 |
$10K |
| D1110 |
Prophylaxis - adult |
175 |
174 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
642 |
586 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
148 |
51 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
14 |
$1K |
| D9420 |
|
15 |
13 |
$878.80 |
| D9986 |
|
931 |
831 |
$0.00 |
| D1999 |
|
2,638 |
2,576 |
$0.00 |
| D9995 |
|
53 |
51 |
$0.00 |
| D0603 |
|
549 |
521 |
$0.00 |