| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,668 |
2,510 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
3,191 |
3,011 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,745 |
2,585 |
$41K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
625 |
219 |
$32K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
626 |
219 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,491 |
1,398 |
$24K |
| D1110 |
Prophylaxis - adult |
642 |
607 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
646 |
495 |
$12K |
| D1351 |
Sealant - per tooth |
618 |
91 |
$3K |
| D0330 |
Panoramic radiographic image |
41 |
38 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
75 |
66 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
198 |
187 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
29 |
18 |
$217.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
89 |
24 |
$40.00 |
| D0220 |
Intraoral - periapical first radiographic image |
57 |
56 |
$26.50 |
| D7111 |
|
19 |
12 |
$0.00 |
| D9420 |
|
14 |
14 |
$0.00 |