| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,094 |
7,040 |
$220K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,288 |
4,251 |
$147K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,903 |
1,134 |
$135K |
| D0272 |
Bitewings - two radiographic images |
6,592 |
6,549 |
$133K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,083 |
7,035 |
$126K |
| D1351 |
Sealant - per tooth |
4,629 |
1,432 |
$108K |
| D0210 |
Intraoral - complete series of radiographic images |
1,727 |
1,714 |
$93K |
| D0240 |
|
6,997 |
4,090 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,373 |
852 |
$75K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,385 |
2,280 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
2,137 |
2,127 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
2,722 |
2,711 |
$61K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
417 |
325 |
$49K |
| D0330 |
Panoramic radiographic image |
591 |
591 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,282 |
2,269 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
316 |
255 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,260 |
2,237 |
$20K |
| D0274 |
Bitewings - four radiographic images |
281 |
279 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
81 |
69 |
$6K |
| D8660 |
|
29 |
29 |
$3K |