| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,444 |
7,394 |
$282K |
| D0120 |
Periodic oral evaluation - established patient |
5,570 |
5,558 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,082 |
932 |
$142K |
| D1206 |
Topical application of fluoride varnish |
6,946 |
6,893 |
$124K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
813 |
165 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,820 |
1,793 |
$69K |
| D1351 |
Sealant - per tooth |
2,261 |
685 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
1,721 |
1,603 |
$60K |
| D9420 |
|
377 |
369 |
$56K |
| D0240 |
|
3,462 |
1,835 |
$55K |
| D0272 |
Bitewings - two radiographic images |
2,549 |
2,500 |
$46K |
| D0603 |
|
6,124 |
6,105 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,389 |
1,291 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
513 |
282 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
269 |
120 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,487 |
508 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
893 |
863 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
103 |
103 |
$6K |
| D1110 |
Prophylaxis - adult |
91 |
91 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
46 |
25 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
136 |
136 |
$4K |
| D0601 |
|
368 |
368 |
$2K |
| D1354 |
|
627 |
217 |
$1K |
| D0274 |
Bitewings - four radiographic images |
42 |
42 |
$1K |
| D1999 |
|
147 |
147 |
$1K |
| D0330 |
Panoramic radiographic image |
35 |
29 |
$390.70 |
| D1330 |
|
6,938 |
6,912 |
$310.02 |
| D1310 |
|
6,934 |
6,911 |
$50.00 |