| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,015 |
5,934 |
$164K |
| D0120 |
Periodic oral evaluation - established patient |
5,395 |
5,337 |
$111K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,393 |
468 |
$101K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,036 |
1,100 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,429 |
1,414 |
$58K |
| D1110 |
Prophylaxis - adult |
814 |
808 |
$49K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,851 |
1,697 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,163 |
700 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,166 |
636 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
1,064 |
1,035 |
$8K |
| D0330 |
Panoramic radiographic image |
508 |
502 |
$8K |
| D9420 |
|
41 |
25 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
3,831 |
3,792 |
$2K |
| D1351 |
Sealant - per tooth |
1,316 |
398 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
407 |
184 |
$2K |
| D9310 |
|
59 |
57 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,789 |
4,654 |
$905.02 |
| D0220 |
Intraoral - periapical first radiographic image |
5,757 |
5,578 |
$691.57 |
| D1330 |
|
6,829 |
6,744 |
$394.69 |
| D1208 |
Topical application of fluoride, excluding varnish |
6,751 |
6,665 |
$356.54 |
| D0210 |
Intraoral - complete series of radiographic images |
55 |
39 |
$245.48 |
| D0601 |
|
1,669 |
1,656 |
$147.00 |
| D0274 |
Bitewings - four radiographic images |
608 |
602 |
$120.97 |
| D0603 |
|
2,797 |
2,618 |
$97.96 |
| D2330 |
|
32 |
13 |
$50.53 |
| D0602 |
|
158 |
158 |
$10.00 |