| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,086 |
7,917 |
$378K |
| D0120 |
Periodic oral evaluation - established patient |
8,400 |
8,227 |
$262K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,962 |
1,041 |
$261K |
| D1206 |
Topical application of fluoride varnish |
9,614 |
9,408 |
$242K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,112 |
511 |
$188K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,066 |
636 |
$129K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
902 |
638 |
$94K |
| D1110 |
Prophylaxis - adult |
1,387 |
1,364 |
$90K |
| D0330 |
Panoramic radiographic image |
1,508 |
1,500 |
$69K |
| D1351 |
Sealant - per tooth |
1,865 |
384 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,219 |
1,192 |
$67K |
| D0272 |
Bitewings - two radiographic images |
2,617 |
2,563 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,831 |
1,711 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
707 |
666 |
$32K |
| D0274 |
Bitewings - four radiographic images |
979 |
955 |
$23K |
| D1330 |
|
1,828 |
1,768 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
37 |
28 |
$6K |
| D3120 |
|
181 |
89 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
61 |
38 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
408 |
383 |
$4K |