| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,249 |
2,216 |
$69K |
| D1110 |
Prophylaxis - adult |
1,474 |
1,441 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
2,357 |
2,320 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,373 |
2,349 |
$42K |
| D8670 |
Periodic orthodontic treatment visit |
401 |
346 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,060 |
1,040 |
$26K |
| D9248 |
|
303 |
290 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
375 |
201 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
734 |
697 |
$20K |
| D1206 |
Topical application of fluoride varnish |
985 |
955 |
$18K |
| D0330 |
Panoramic radiographic image |
412 |
405 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
223 |
114 |
$13K |
| D0272 |
Bitewings - two radiographic images |
733 |
723 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
150 |
94 |
$10K |
| D1351 |
Sealant - per tooth |
245 |
95 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
559 |
547 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
65 |
40 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
29 |
14 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
186 |
108 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$380.25 |