| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,825 |
9,010 |
$379K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,237 |
1,367 |
$305K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,013 |
9,153 |
$240K |
| D0120 |
Periodic oral evaluation - established patient |
7,645 |
7,005 |
$223K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,821 |
2,350 |
$144K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,543 |
549 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,799 |
1,621 |
$96K |
| D0330 |
Panoramic radiographic image |
1,282 |
1,186 |
$92K |
| D1351 |
Sealant - per tooth |
2,610 |
775 |
$81K |
| D0272 |
Bitewings - two radiographic images |
2,985 |
2,730 |
$80K |
| D7140 |
Extraction, erupted tooth or exposed root |
647 |
340 |
$65K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
299 |
81 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,003 |
895 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,498 |
2,144 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
323 |
208 |
$39K |
| D2332 |
|
145 |
79 |
$23K |
| D0274 |
Bitewings - four radiographic images |
509 |
461 |
$20K |
| D0240 |
|
606 |
423 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
86 |
38 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
508 |
260 |
$7K |
| D1354 |
|
495 |
117 |
$3K |