| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,522 |
11,410 |
$87K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,915 |
1,814 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,051 |
13,910 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
10,918 |
10,836 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,748 |
8,013 |
$46K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,210 |
583 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,399 |
2,365 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
9,263 |
9,072 |
$20K |
| D9248 |
|
1,188 |
1,138 |
$16K |
| D0274 |
Bitewings - four radiographic images |
2,797 |
2,760 |
$13K |
| D1351 |
Sealant - per tooth |
2,106 |
660 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
679 |
358 |
$9K |
| D1110 |
Prophylaxis - adult |
1,650 |
1,634 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
762 |
452 |
$7K |
| D0272 |
Bitewings - two radiographic images |
2,569 |
2,552 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
1,304 |
1,248 |
$7K |
| D0330 |
Panoramic radiographic image |
1,469 |
1,452 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
948 |
909 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
215 |
137 |
$4K |
| D1999 |
|
3,510 |
3,285 |
$1K |
| D1354 |
|
43 |
16 |
$88.19 |
| D0190 |
|
25 |
25 |
$52.84 |
| D9995 |
|
25 |
19 |
$44.16 |
| D0603 |
|
881 |
782 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
21 |
21 |
$0.00 |
| D0602 |
|
14 |
14 |
$0.00 |