| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,485 |
2,433 |
$110K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,193 |
725 |
$82K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
309 |
243 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,089 |
1,066 |
$43K |
| D1110 |
Prophylaxis - adult |
1,103 |
1,081 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
674 |
659 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
707 |
481 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
371 |
297 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
2,802 |
2,743 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,802 |
1,446 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,026 |
3,151 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
700 |
673 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,609 |
3,534 |
$8K |
| D1330 |
|
3,410 |
3,335 |
$7K |
| D0272 |
Bitewings - two radiographic images |
1,916 |
1,878 |
$6K |
| D1351 |
Sealant - per tooth |
1,595 |
628 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
3,641 |
3,506 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
20 |
15 |
$671.85 |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$238.45 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$185.52 |
| D1999 |
|
328 |
261 |
$0.00 |