| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,410 |
6,300 |
$327K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,944 |
2,210 |
$320K |
| D1110 |
Prophylaxis - adult |
3,552 |
3,480 |
$160K |
| D0120 |
Periodic oral evaluation - established patient |
7,788 |
7,662 |
$151K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,061 |
1,281 |
$105K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,370 |
6,260 |
$93K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,073 |
1,962 |
$75K |
| D0274 |
Bitewings - four radiographic images |
2,521 |
2,489 |
$73K |
| D0330 |
Panoramic radiographic image |
1,807 |
1,780 |
$71K |
| D1351 |
Sealant - per tooth |
2,749 |
733 |
$57K |
| D0272 |
Bitewings - two radiographic images |
3,151 |
3,095 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,207 |
2,150 |
$53K |
| D0140 |
Limited oral evaluation - problem focused |
1,318 |
1,275 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
879 |
527 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
236 |
163 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,071 |
1,044 |
$10K |
| D2331 |
|
58 |
39 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
38 |
14 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
47 |
25 |
$3K |
| D9248 |
|
53 |
52 |
$1K |
| D2330 |
|
13 |
12 |
$730.40 |