| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,119 |
7,914 |
$401K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,910 |
1,803 |
$291K |
| D0120 |
Periodic oral evaluation - established patient |
10,316 |
10,025 |
$282K |
| D1206 |
Topical application of fluoride varnish |
10,239 |
9,948 |
$257K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,673 |
1,852 |
$217K |
| D1110 |
Prophylaxis - adult |
3,039 |
2,908 |
$178K |
| D1351 |
Sealant - per tooth |
4,254 |
1,511 |
$164K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,355 |
912 |
$127K |
| D0272 |
Bitewings - two radiographic images |
4,341 |
4,235 |
$126K |
| D0274 |
Bitewings - four radiographic images |
2,784 |
2,668 |
$108K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,093 |
724 |
$98K |
| D0220 |
Intraoral - periapical first radiographic image |
2,901 |
2,702 |
$52K |
| D1354 |
|
3,635 |
522 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
870 |
833 |
$49K |
| D0330 |
Panoramic radiographic image |
591 |
576 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
366 |
263 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,481 |
2,184 |
$35K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
85 |
57 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
328 |
312 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
55 |
48 |
$6K |
| D2140 |
|
19 |
16 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
45 |
43 |
$882.00 |
| D1330 |
|
446 |
443 |
$0.00 |
| D1999 |
|
36 |
33 |
$0.00 |