| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,673 |
5,569 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
4,971 |
4,917 |
$29K |
| D1206 |
Topical application of fluoride varnish |
6,433 |
6,314 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,167 |
3,231 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
4,983 |
4,875 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,199 |
1,147 |
$9K |
| D0272 |
Bitewings - two radiographic images |
2,087 |
2,035 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
966 |
525 |
$6K |
| D0274 |
Bitewings - four radiographic images |
1,442 |
1,407 |
$5K |
| D0330 |
Panoramic radiographic image |
393 |
381 |
$5K |
| D1351 |
Sealant - per tooth |
1,158 |
388 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
264 |
143 |
$4K |
| D1110 |
Prophylaxis - adult |
500 |
493 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
221 |
210 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
534 |
482 |
$1K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
123 |
23 |
$850.40 |
| D1208 |
Topical application of fluoride, excluding varnish |
329 |
329 |
$598.01 |
| D0240 |
|
380 |
354 |
$348.83 |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
18 |
$256.04 |
| D0160 |
|
19 |
19 |
$30.86 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$28.58 |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$27.70 |
| D1999 |
|
1,455 |
1,275 |
$11.74 |
| D2934 |
|
55 |
12 |
$0.00 |
| D0603 |
|
745 |
699 |
$0.00 |
| D0601 |
|
315 |
290 |
$0.00 |
| D0602 |
|
207 |
201 |
$0.00 |
| D3230 |
|
55 |
12 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
58 |
17 |
$0.00 |