| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,063 |
7,001 |
$200K |
| D9920 |
|
3,046 |
2,936 |
$166K |
| D0120 |
Periodic oral evaluation - established patient |
8,615 |
8,534 |
$143K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,668 |
960 |
$116K |
| D1206 |
Topical application of fluoride varnish |
6,371 |
6,314 |
$100K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,583 |
992 |
$94K |
| D1110 |
Prophylaxis - adult |
2,497 |
2,468 |
$91K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,356 |
780 |
$73K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,214 |
1,996 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,828 |
2,807 |
$58K |
| D1351 |
Sealant - per tooth |
2,257 |
821 |
$58K |
| D0272 |
Bitewings - two radiographic images |
2,250 |
2,232 |
$38K |
| D9630 |
|
1,598 |
1,562 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,038 |
1,028 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
777 |
769 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,826 |
1,788 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
911 |
756 |
$6K |
| D0330 |
Panoramic radiographic image |
182 |
182 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
215 |
213 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
69 |
38 |
$3K |
| D0240 |
|
191 |
106 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
18 |
12 |
$1K |
| D9310 |
|
14 |
13 |
$1K |
| D3120 |
|
48 |
37 |
$1K |