| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,945 |
5,735 |
$267K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,683 |
7,404 |
$186K |
| D0272 |
Bitewings - two radiographic images |
6,893 |
6,636 |
$117K |
| D1206 |
Topical application of fluoride varnish |
8,204 |
7,908 |
$115K |
| D1110 |
Prophylaxis - adult |
2,309 |
2,218 |
$100K |
| D0330 |
Panoramic radiographic image |
2,421 |
2,326 |
$88K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,105 |
798 |
$72K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,097 |
643 |
$67K |
| D1351 |
Sealant - per tooth |
3,329 |
824 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
5,059 |
4,867 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,842 |
4,652 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
885 |
822 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
596 |
477 |
$32K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
483 |
415 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
494 |
340 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
598 |
568 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
65 |
50 |
$6K |
| D2330 |
|
81 |
59 |
$4K |
| D2160 |
|
47 |
45 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
23 |
22 |
$759.00 |
| D3110 |
|
36 |
34 |
$595.00 |
| D9986 |
|
411 |
297 |
$0.00 |