| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,523 |
7,373 |
$88K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,299 |
931 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
6,248 |
6,113 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,804 |
5,691 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,217 |
2,181 |
$27K |
| D0272 |
Bitewings - two radiographic images |
3,290 |
3,211 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
4,433 |
4,320 |
$17K |
| D0330 |
Panoramic radiographic image |
904 |
885 |
$16K |
| D1351 |
Sealant - per tooth |
2,319 |
688 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
679 |
370 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,071 |
3,897 |
$13K |
| D1206 |
Topical application of fluoride varnish |
2,121 |
2,081 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
294 |
109 |
$11K |
| D1110 |
Prophylaxis - adult |
678 |
666 |
$8K |
| D1354 |
|
1,182 |
263 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
239 |
138 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
514 |
498 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
563 |
512 |
$4K |
| D0274 |
Bitewings - four radiographic images |
426 |
419 |
$4K |
| D9248 |
|
58 |
54 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
47 |
24 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
27 |
$884.94 |
| D2332 |
|
24 |
13 |
$768.42 |
| D1999 |
|
44 |
36 |
$6.00 |
| D0603 |
|
23 |
13 |
$0.00 |