| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,449 |
8,433 |
$304K |
| D0120 |
Periodic oral evaluation - established patient |
7,786 |
7,773 |
$266K |
| D1206 |
Topical application of fluoride varnish |
8,562 |
8,546 |
$214K |
| D0272 |
Bitewings - two radiographic images |
6,317 |
6,301 |
$140K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,665 |
1,044 |
$120K |
| D1351 |
Sealant - per tooth |
3,931 |
993 |
$104K |
| D7960 |
|
187 |
187 |
$71K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
417 |
243 |
$56K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
408 |
303 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
652 |
432 |
$37K |
| D0603 |
|
3,131 |
3,128 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
680 |
680 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
293 |
184 |
$21K |
| D2332 |
|
209 |
123 |
$19K |
| D9920 |
|
311 |
304 |
$12K |
| D9430 |
|
508 |
498 |
$11K |
| D8670 |
Periodic orthodontic treatment visit |
174 |
173 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
131 |
83 |
$10K |
| D0330 |
Panoramic radiographic image |
200 |
200 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
744 |
720 |
$7K |
| D0240 |
|
379 |
377 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
312 |
289 |
$6K |
| D8660 |
|
128 |
128 |
$6K |
| D1110 |
Prophylaxis - adult |
165 |
165 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
146 |
146 |
$5K |
| D0602 |
|
373 |
373 |
$4K |
| D0601 |
|
306 |
306 |
$3K |
| D2330 |
|
18 |
12 |
$911.50 |
| D9310 |
|
50 |
50 |
$750.00 |