| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,046 |
5,845 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,047 |
923 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
5,446 |
5,320 |
$5K |
| D0272 |
Bitewings - two radiographic images |
4,133 |
3,960 |
$4K |
| D1206 |
Topical application of fluoride varnish |
6,502 |
6,265 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
6,691 |
6,335 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,448 |
746 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,190 |
5,582 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
882 |
292 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
856 |
403 |
$2K |
| D0274 |
Bitewings - four radiographic images |
827 |
797 |
$2K |
| D1351 |
Sealant - per tooth |
634 |
183 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
73 |
73 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
546 |
526 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,170 |
1,075 |
$543.24 |
| D0140 |
Limited oral evaluation - problem focused |
870 |
760 |
$531.95 |
| D1110 |
Prophylaxis - adult |
368 |
351 |
$339.43 |
| D0603 |
|
2,846 |
2,546 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
61 |
61 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
669 |
152 |
$0.00 |
| D3230 |
|
532 |
91 |
$0.00 |
| D1999 |
|
1,595 |
1,495 |
$0.00 |
| D0330 |
Panoramic radiographic image |
610 |
590 |
$0.00 |
| D0160 |
|
311 |
274 |
$0.00 |
| D2934 |
|
471 |
78 |
$0.00 |