| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
2,196 |
1,084 |
$184K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,678 |
1,671 |
$111K |
| D1120 |
Prophylaxis - child |
1,975 |
1,969 |
$102K |
| D0350 |
|
9,065 |
1,944 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
986 |
985 |
$67K |
| D1110 |
Prophylaxis - adult |
714 |
710 |
$64K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
529 |
294 |
$52K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,302 |
1,007 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,830 |
2,801 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
979 |
977 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,620 |
1,888 |
$35K |
| D1320 |
|
1,523 |
1,517 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
225 |
179 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
173 |
137 |
$14K |
| D1351 |
Sealant - per tooth |
335 |
105 |
$13K |
| D1310 |
|
320 |
320 |
$12K |
| D0272 |
Bitewings - two radiographic images |
992 |
987 |
$12K |
| D2740 |
Crown - porcelain/ceramic |
23 |
15 |
$11K |
| D0274 |
Bitewings - four radiographic images |
464 |
464 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
153 |
111 |
$9K |
| D9430 |
|
105 |
102 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
27 |
26 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
39 |
$3K |
| D2335 |
|
22 |
13 |
$3K |
| D2332 |
|
31 |
25 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
181 |
177 |
$2K |
| D0601 |
|
41 |
41 |
$600.00 |
| D0603 |
|
49 |
49 |
$435.00 |
| D0602 |
|
20 |
20 |
$270.00 |