| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0272 |
Bitewings - two radiographic images |
5,878 |
5,822 |
$0.00 |
| D0603 |
|
3,628 |
3,584 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
5,624 |
5,553 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,903 |
4,412 |
$0.00 |
| D8670 |
Periodic orthodontic treatment visit |
265 |
259 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
343 |
307 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
459 |
442 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
5,758 |
5,670 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
13 |
13 |
$0.00 |
| D1351 |
Sealant - per tooth |
2,748 |
1,762 |
$0.00 |
| D7961 |
|
72 |
63 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
157 |
157 |
$0.00 |
| D2331 |
|
26 |
25 |
$0.00 |
| D9920 |
|
46 |
46 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
30 |
26 |
$0.00 |
| D7962 |
|
13 |
12 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
843 |
786 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
885 |
818 |
$0.00 |
| D1120 |
Prophylaxis - child |
6,218 |
6,166 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,260 |
3,178 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
2,811 |
2,743 |
$0.00 |
| D2332 |
|
89 |
86 |
$0.00 |
| D9430 |
|
64 |
64 |
$0.00 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$0.00 |