| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,520 |
6,321 |
$265K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,373 |
6,180 |
$165K |
| D0120 |
Periodic oral evaluation - established patient |
5,537 |
5,375 |
$154K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,044 |
1,528 |
$133K |
| D9110 |
|
1,317 |
1,216 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
834 |
654 |
$34K |
| D0272 |
Bitewings - two radiographic images |
2,432 |
2,352 |
$24K |
| D1351 |
Sealant - per tooth |
336 |
203 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,009 |
955 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
305 |
220 |
$20K |
| D0274 |
Bitewings - four radiographic images |
677 |
667 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
252 |
241 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
979 |
912 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
158 |
140 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
24 |
$2K |
| D2394 |
|
17 |
12 |
$986.85 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
14 |
14 |
$843.20 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
13 |
$68.40 |
| D1999 |
|
121 |
106 |
$0.00 |