| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,912 |
7,656 |
$157K |
| D0120 |
Periodic oral evaluation - established patient |
7,330 |
7,145 |
$93K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,910 |
9,571 |
$91K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,316 |
547 |
$70K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,358 |
542 |
$46K |
| D0330 |
Panoramic radiographic image |
1,741 |
1,658 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,552 |
641 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,894 |
1,753 |
$38K |
| D1110 |
Prophylaxis - adult |
1,686 |
1,619 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
935 |
477 |
$30K |
| D0274 |
Bitewings - four radiographic images |
2,323 |
2,217 |
$26K |
| D0272 |
Bitewings - two radiographic images |
2,607 |
2,533 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
498 |
221 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
180 |
175 |
$4K |
| D1206 |
Topical application of fluoride varnish |
187 |
181 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
500 |
473 |
$3K |
| D1351 |
Sealant - per tooth |
267 |
76 |
$2K |
| D0240 |
|
239 |
138 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
91 |
86 |
$793.79 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
14 |
$10.73 |
| D0603 |
|
159 |
146 |
$0.00 |
| D0601 |
|
1,343 |
1,107 |
$0.00 |
| D0602 |
|
6,189 |
5,158 |
$0.00 |
| D9222 |
|
31 |
17 |
$0.00 |