| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,120 |
3,465 |
$118K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,520 |
1,099 |
$112K |
| D1120 |
Prophylaxis - child |
3,219 |
3,163 |
$105K |
| D1206 |
Topical application of fluoride varnish |
5,103 |
5,002 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
3,577 |
3,480 |
$84K |
| D1110 |
Prophylaxis - adult |
2,010 |
1,953 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
812 |
636 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,344 |
1,317 |
$37K |
| D0330 |
Panoramic radiographic image |
766 |
751 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,104 |
1,072 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,441 |
1,412 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
244 |
175 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
128 |
86 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
120 |
88 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
418 |
400 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
417 |
399 |
$5K |
| D2931 |
|
17 |
12 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
26 |
20 |
$2K |
| D1351 |
Sealant - per tooth |
55 |
16 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
111 |
51 |
$796.83 |
| D1354 |
|
111 |
27 |
$577.17 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$203.88 |
| D9986 |
|
1,965 |
1,905 |
$0.00 |