| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,393 |
6,116 |
$160K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,413 |
3,948 |
$143K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,865 |
760 |
$121K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,363 |
6,091 |
$92K |
| D0274 |
Bitewings - four radiographic images |
3,964 |
3,122 |
$87K |
| D0330 |
Panoramic radiographic image |
1,707 |
1,481 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
770 |
420 |
$67K |
| D1351 |
Sealant - per tooth |
3,350 |
587 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
2,591 |
1,957 |
$50K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
218 |
57 |
$29K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
262 |
106 |
$22K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
173 |
38 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
241 |
220 |
$8K |
| D0272 |
Bitewings - two radiographic images |
286 |
233 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
278 |
209 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
258 |
218 |
$3K |
| D2140 |
|
36 |
15 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
13 |
$2K |
| D1110 |
Prophylaxis - adult |
25 |
25 |
$1K |