| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,988 |
6,681 |
$283K |
| D0120 |
Periodic oral evaluation - established patient |
6,599 |
6,315 |
$183K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,535 |
5,263 |
$143K |
| D1351 |
Sealant - per tooth |
1,370 |
1,124 |
$107K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,499 |
1,262 |
$99K |
| D0272 |
Bitewings - two radiographic images |
2,498 |
2,373 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
515 |
453 |
$20K |
| D0274 |
Bitewings - four radiographic images |
969 |
911 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
122 |
108 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
101 |
88 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
126 |
107 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,440 |
1,344 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
147 |
133 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
115 |
99 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
208 |
202 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
297 |
287 |
$2K |
| D2140 |
|
30 |
27 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
42 |
40 |
$615.60 |
| D2940 |
|
51 |
47 |
$0.00 |