| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,209 |
3,142 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,019 |
570 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,304 |
790 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
3,784 |
3,708 |
$20K |
| D0272 |
Bitewings - two radiographic images |
3,244 |
3,168 |
$16K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
487 |
181 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,731 |
3,640 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
261 |
119 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,603 |
1,404 |
$12K |
| D9248 |
|
414 |
357 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
2,092 |
2,030 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
139 |
69 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
97 |
69 |
$3K |
| D0330 |
Panoramic radiographic image |
262 |
256 |
$3K |
| D1999 |
|
1,005 |
832 |
$3K |
| D1110 |
Prophylaxis - adult |
362 |
354 |
$1K |
| D1351 |
Sealant - per tooth |
185 |
91 |
$1K |
| D0274 |
Bitewings - four radiographic images |
313 |
307 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
86 |
84 |
$876.29 |
| D0230 |
Intraoral - periapical each additional radiographic image |
223 |
183 |
$629.88 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$0.00 |