| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,521 |
4,501 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
4,383 |
4,372 |
$74K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
607 |
339 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,133 |
4,117 |
$61K |
| D1351 |
Sealant - per tooth |
1,495 |
441 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,191 |
1,180 |
$30K |
| D0330 |
Panoramic radiographic image |
647 |
646 |
$29K |
| D0272 |
Bitewings - two radiographic images |
2,985 |
2,971 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
450 |
341 |
$25K |
| D1110 |
Prophylaxis - adult |
754 |
746 |
$25K |
| D0240 |
|
1,885 |
1,092 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,308 |
1,305 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,909 |
1,320 |
$16K |
| D0274 |
Bitewings - four radiographic images |
713 |
709 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
438 |
347 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
202 |
135 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
2,146 |
2,105 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
398 |
393 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
119 |
88 |
$6K |
| D2140 |
|
96 |
66 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
56 |
41 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
40 |
36 |
$2K |
| D1510 |
|
14 |
13 |
$2K |
| D0251 |
|
23 |
22 |
$242.28 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
38 |
37 |
$75.00 |