| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,908 |
1,853 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,044 |
1,982 |
$55K |
| D1206 |
Topical application of fluoride varnish |
2,282 |
2,210 |
$31K |
| D0272 |
Bitewings - two radiographic images |
940 |
918 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,715 |
1,108 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,372 |
1,320 |
$16K |
| D1110 |
Prophylaxis - adult |
203 |
199 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
66 |
63 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
26 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
27 |
12 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
15 |
$4K |
| D9248 |
|
31 |
27 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
86 |
84 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
100 |
94 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
26 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
88 |
84 |
$2K |
| D0603 |
|
504 |
491 |
$0.00 |
| D0602 |
|
251 |
250 |
$0.00 |
| D0601 |
|
1,541 |
1,484 |
$0.00 |