| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,067 |
5,345 |
$168K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,449 |
1,023 |
$141K |
| D1206 |
Topical application of fluoride varnish |
7,665 |
6,781 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
7,134 |
6,324 |
$136K |
| D1351 |
Sealant - per tooth |
3,656 |
601 |
$85K |
| D0272 |
Bitewings - two radiographic images |
3,200 |
2,853 |
$65K |
| D1110 |
Prophylaxis - adult |
1,710 |
1,497 |
$65K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,891 |
1,517 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
956 |
514 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
416 |
169 |
$27K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
211 |
98 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
844 |
735 |
$25K |
| D0330 |
Panoramic radiographic image |
272 |
257 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
964 |
836 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
266 |
244 |
$7K |
| D0274 |
Bitewings - four radiographic images |
200 |
187 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
533 |
191 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
56 |
28 |
$5K |
| D0160 |
|
81 |
75 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D1999 |
|
2,063 |
1,717 |
$0.00 |
| D0602 |
|
14 |
14 |
$0.00 |
| D3120 |
|
115 |
74 |
$0.00 |
| D0603 |
|
127 |
122 |
$0.00 |