| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,582 |
5,560 |
$226K |
| D0120 |
Periodic oral evaluation - established patient |
5,433 |
5,408 |
$151K |
| D1206 |
Topical application of fluoride varnish |
5,183 |
5,172 |
$134K |
| D1351 |
Sealant - per tooth |
2,373 |
1,251 |
$122K |
| D1354 |
|
432 |
218 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
129 |
95 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
132 |
124 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
44 |
25 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
232 |
232 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
190 |
190 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
483 |
396 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
36 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
34 |
21 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
466 |
457 |
$3K |
| D0274 |
Bitewings - four radiographic images |
83 |
83 |
$1K |
| D2940 |
|
62 |
50 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
15 |
$837.20 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$248.56 |
| D0601 |
|
2,025 |
2,022 |
$0.00 |
| D0603 |
|
605 |
603 |
$0.00 |
| D0602 |
|
987 |
987 |
$0.00 |