| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,529 |
4,385 |
$111K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
911 |
253 |
$111K |
| D1120 |
Prophylaxis - child |
3,237 |
3,129 |
$106K |
| D1206 |
Topical application of fluoride varnish |
4,579 |
4,448 |
$83K |
| D0272 |
Bitewings - two radiographic images |
3,021 |
2,950 |
$69K |
| D0240 |
|
2,781 |
1,385 |
$65K |
| D1110 |
Prophylaxis - adult |
1,226 |
1,206 |
$55K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
588 |
260 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
608 |
284 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,518 |
1,424 |
$36K |
| D9248 |
|
247 |
231 |
$20K |
| D0603 |
|
4,740 |
4,584 |
$18K |
| D1351 |
Sealant - per tooth |
631 |
239 |
$15K |
| D0330 |
Panoramic radiographic image |
280 |
263 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
764 |
735 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
615 |
563 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
93 |
56 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
130 |
126 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
104 |
104 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
26 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
20 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
15 |
$1K |
| D0274 |
Bitewings - four radiographic images |
34 |
34 |
$765.70 |
| D9215 |
|
31 |
31 |
$0.00 |