| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,895 |
2,884 |
$132K |
| D1206 |
Topical application of fluoride varnish |
2,837 |
2,826 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,163 |
620 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
2,800 |
2,794 |
$76K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,617 |
1,527 |
$41K |
| D9999 |
Unspecified adjunctive procedure, by report |
83 |
79 |
$33K |
| D9248 |
|
219 |
110 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
229 |
113 |
$22K |
| D1351 |
Sealant - per tooth |
650 |
220 |
$13K |
| D0272 |
Bitewings - two radiographic images |
949 |
945 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
146 |
83 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
177 |
109 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
158 |
100 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
268 |
267 |
$6K |
| D0240 |
|
207 |
202 |
$4K |
| D0602 |
|
386 |
385 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
638 |
629 |
$3K |
| D0603 |
|
354 |
349 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
251 |
248 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
62 |
62 |
$2K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$480.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$475.00 |
| D0601 |
|
41 |
41 |
$410.00 |