| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,079 |
6,706 |
$288K |
| D0120 |
Periodic oral evaluation - established patient |
8,288 |
7,871 |
$227K |
| D9110 |
|
2,868 |
2,722 |
$156K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,503 |
5,251 |
$144K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,190 |
881 |
$128K |
| D1351 |
Sealant - per tooth |
928 |
511 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
982 |
721 |
$79K |
| D1110 |
Prophylaxis - adult |
1,439 |
1,381 |
$58K |
| D7140 |
Extraction, erupted tooth or exposed root |
880 |
694 |
$55K |
| D0274 |
Bitewings - four radiographic images |
3,127 |
2,970 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
5,896 |
5,461 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,674 |
4,281 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
326 |
246 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
199 |
190 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
544 |
527 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,102 |
1,037 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
66 |
45 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
90 |
65 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
265 |
258 |
$7K |
| D2750 |
|
20 |
13 |
$7K |
| D0330 |
Panoramic radiographic image |
183 |
181 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
268 |
257 |
$5K |
| D2950 |
|
34 |
25 |
$2K |