| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,220 |
4,194 |
$161K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,386 |
598 |
$153K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,658 |
769 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
3,695 |
3,674 |
$121K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
595 |
245 |
$95K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
507 |
496 |
$86K |
| D0272 |
Bitewings - two radiographic images |
3,800 |
3,772 |
$83K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,106 |
651 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,257 |
3,231 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
3,981 |
3,937 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,789 |
3,742 |
$49K |
| D1206 |
Topical application of fluoride varnish |
1,040 |
1,040 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
834 |
824 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
705 |
695 |
$27K |
| D1351 |
Sealant - per tooth |
836 |
281 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
94 |
55 |
$9K |
| D2330 |
|
90 |
50 |
$7K |
| D9420 |
|
13 |
13 |
$5K |
| D7999 |
|
12 |
12 |
$5K |
| D0330 |
Panoramic radiographic image |
38 |
38 |
$2K |