| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,686 |
5,313 |
$158K |
| D0120 |
Periodic oral evaluation - established patient |
9,064 |
7,140 |
$144K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,155 |
7,147 |
$143K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,468 |
936 |
$127K |
| D1351 |
Sealant - per tooth |
6,048 |
1,189 |
$105K |
| D1110 |
Prophylaxis - adult |
3,001 |
2,326 |
$85K |
| D0272 |
Bitewings - two radiographic images |
4,880 |
3,784 |
$84K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,985 |
2,054 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,822 |
1,043 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,597 |
1,170 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
659 |
333 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,123 |
872 |
$25K |
| D0330 |
Panoramic radiographic image |
356 |
290 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
240 |
148 |
$11K |
| D9248 |
|
76 |
61 |
$731.50 |
| D9920 |
|
178 |
155 |
$701.25 |
| D0220 |
Intraoral - periapical first radiographic image |
210 |
178 |
$662.50 |
| D2332 |
|
20 |
12 |
$446.32 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
126 |
90 |
$315.33 |
| D1999 |
|
159 |
143 |
$30.00 |