| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,142 |
1,731 |
$75K |
| D1206 |
Topical application of fluoride varnish |
2,181 |
1,782 |
$60K |
| D1351 |
Sealant - per tooth |
2,587 |
451 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,075 |
374 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,370 |
1,092 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
816 |
688 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
661 |
278 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
708 |
547 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
1,211 |
980 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
390 |
123 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,369 |
1,896 |
$16K |
| D0330 |
Panoramic radiographic image |
501 |
423 |
$16K |
| D7111 |
|
775 |
198 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
247 |
228 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
361 |
118 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,171 |
1,729 |
$10K |
| D0350 |
|
5,632 |
1,703 |
$8K |
| D9420 |
|
306 |
191 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
456 |
352 |
$6K |
| D0272 |
Bitewings - two radiographic images |
395 |
317 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
255 |
183 |
$3K |
| D0240 |
|
294 |
181 |
$3K |
| D0603 |
|
897 |
846 |
$2K |
| D0602 |
|
576 |
543 |
$2K |
| D4346 |
|
25 |
25 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$826.15 |
| D0601 |
|
93 |
65 |
$275.00 |
| D9986 |
|
12 |
12 |
$0.00 |