| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,848 |
3,744 |
$178K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,162 |
680 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
3,868 |
3,765 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
393 |
377 |
$31K |
| D0330 |
Panoramic radiographic image |
295 |
284 |
$27K |
| D1110 |
Prophylaxis - adult |
340 |
328 |
$22K |
| D1351 |
Sealant - per tooth |
874 |
378 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
258 |
190 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
149 |
106 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,241 |
3,009 |
$8K |
| D0272 |
Bitewings - two radiographic images |
2,694 |
2,630 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
3,356 |
3,235 |
$7K |
| D9920 |
|
181 |
162 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
273 |
168 |
$5K |
| D1206 |
Topical application of fluoride varnish |
4,103 |
3,984 |
$3K |
| D1330 |
|
4,095 |
3,979 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
143 |
139 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,016 |
916 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
17 |
17 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
91 |
91 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
14 |
$600.48 |
| D0240 |
|
14 |
14 |
$474.17 |
| D0274 |
Bitewings - four radiographic images |
715 |
689 |
$431.41 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
73 |
53 |
$148.64 |
| D3120 |
|
84 |
66 |
$0.00 |
| D0601 |
|
37 |
32 |
$0.00 |
| D0603 |
|
47 |
39 |
$0.00 |
| D0602 |
|
14 |
14 |
$0.00 |