| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,025 |
10,678 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,672 |
1,745 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
11,027 |
10,643 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,443 |
7,253 |
$17K |
| D0272 |
Bitewings - two radiographic images |
6,439 |
6,216 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
7,501 |
7,186 |
$8K |
| D1110 |
Prophylaxis - adult |
1,852 |
1,790 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,235 |
6,474 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,868 |
1,798 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
692 |
340 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
618 |
244 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
646 |
251 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
892 |
854 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,213 |
1,124 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
120 |
81 |
$2K |
| D1351 |
Sealant - per tooth |
670 |
206 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
534 |
281 |
$1K |
| D1206 |
Topical application of fluoride varnish |
4,159 |
3,952 |
$785.67 |
| D0330 |
Panoramic radiographic image |
246 |
238 |
$726.50 |
| D9310 |
|
27 |
26 |
$80.26 |
| D0274 |
Bitewings - four radiographic images |
14 |
12 |
$31.54 |
| D1999 |
|
1,870 |
1,723 |
$0.00 |
| D0602 |
|
38 |
38 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
69 |
63 |
$0.00 |
| D1330 |
|
2,637 |
2,416 |
$0.00 |
| D0601 |
|
205 |
202 |
$0.00 |
| D3120 |
|
43 |
27 |
$0.00 |
| D9248 |
|
15 |
14 |
$0.00 |