| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,649 |
7,425 |
$382K |
| D1206 |
Topical application of fluoride varnish |
8,800 |
8,598 |
$227K |
| D0120 |
Periodic oral evaluation - established patient |
7,357 |
7,176 |
$206K |
| D1351 |
Sealant - per tooth |
3,056 |
800 |
$117K |
| D1110 |
Prophylaxis - adult |
1,460 |
1,430 |
$93K |
| D0272 |
Bitewings - two radiographic images |
2,735 |
2,671 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,237 |
1,198 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
599 |
352 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,267 |
1,240 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
533 |
371 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
1,393 |
1,265 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
222 |
131 |
$18K |
| D0330 |
Panoramic radiographic image |
167 |
165 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
481 |
328 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16 |
12 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
69 |
64 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
86 |
84 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
12 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
16 |
13 |
$1K |
| D1999 |
|
118 |
110 |
$0.00 |