| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,568 |
8,444 |
$106K |
| D1999 |
|
6,095 |
5,487 |
$84K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,337 |
1,301 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
7,458 |
7,352 |
$64K |
| D1206 |
Topical application of fluoride varnish |
9,027 |
8,899 |
$59K |
| D0272 |
Bitewings - two radiographic images |
6,640 |
6,548 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,355 |
914 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,822 |
1,793 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,316 |
2,140 |
$18K |
| D1110 |
Prophylaxis - adult |
897 |
879 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
3,479 |
3,382 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
204 |
114 |
$11K |
| D0274 |
Bitewings - four radiographic images |
1,073 |
1,046 |
$11K |
| D0330 |
Panoramic radiographic image |
509 |
501 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,631 |
3,065 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
340 |
194 |
$9K |
| D1351 |
Sealant - per tooth |
529 |
177 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
334 |
323 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
22 |
12 |
$767.26 |
| D9248 |
|
12 |
12 |
$600.04 |
| D0145 |
Oral evaluation for a patient under three years of age |
84 |
82 |
$431.43 |
| D0210 |
Intraoral - complete series of radiographic images |
91 |
90 |
$126.50 |
| D0603 |
|
2,789 |
2,690 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
300 |
297 |
$0.00 |
| D1330 |
|
884 |
846 |
$0.00 |
| D0601 |
|
152 |
150 |
$0.00 |
| D0602 |
|
77 |
77 |
$0.00 |