| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,980 |
3,898 |
$106K |
| D1120 |
Prophylaxis - child |
3,053 |
2,992 |
$103K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
551 |
287 |
$73K |
| D0272 |
Bitewings - two radiographic images |
3,000 |
2,928 |
$64K |
| D1206 |
Topical application of fluoride varnish |
4,177 |
4,092 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
547 |
320 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,768 |
1,572 |
$33K |
| D1110 |
Prophylaxis - adult |
438 |
422 |
$21K |
| D0274 |
Bitewings - four radiographic images |
393 |
379 |
$12K |
| D9248 |
|
107 |
102 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
122 |
67 |
$9K |
| D1351 |
Sealant - per tooth |
311 |
106 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
87 |
65 |
$6K |
| D0240 |
|
220 |
123 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
54 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
12 |
$1K |
| D0601 |
|
1,451 |
1,436 |
$0.00 |
| D0602 |
|
2,603 |
2,561 |
$0.00 |
| D1999 |
|
183 |
169 |
$0.00 |