| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,173 |
6,556 |
$168K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,049 |
1,307 |
$134K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,986 |
3,849 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,395 |
1,022 |
$124K |
| D1351 |
Sealant - per tooth |
5,619 |
1,703 |
$108K |
| D1206 |
Topical application of fluoride varnish |
3,863 |
3,708 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
3,237 |
2,803 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,818 |
2,378 |
$61K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
470 |
317 |
$54K |
| D0330 |
Panoramic radiographic image |
1,344 |
1,260 |
$48K |
| D0272 |
Bitewings - two radiographic images |
2,932 |
2,683 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,917 |
1,735 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,250 |
2,834 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,776 |
3,417 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,962 |
2,511 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
191 |
144 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
216 |
216 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
153 |
152 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
14 |
12 |
$1K |
| D2330 |
|
16 |
12 |
$1K |
| D1999 |
|
933 |
879 |
$0.00 |