| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,020 |
10,799 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
12,131 |
11,889 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,691 |
15,376 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,897 |
1,792 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,306 |
14,104 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
15,338 |
14,973 |
$36K |
| D0272 |
Bitewings - two radiographic images |
7,815 |
7,663 |
$28K |
| D0274 |
Bitewings - four radiographic images |
4,693 |
4,577 |
$27K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,339 |
368 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,408 |
2,338 |
$22K |
| D1110 |
Prophylaxis - adult |
2,475 |
2,418 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,696 |
1,183 |
$21K |
| D1351 |
Sealant - per tooth |
4,084 |
1,244 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
847 |
503 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,748 |
1,538 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
637 |
619 |
$4K |
| D1353 |
|
748 |
226 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
61 |
25 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
68 |
66 |
$265.44 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$190.64 |
| D0602 |
|
140 |
139 |
$0.00 |
| D0601 |
|
586 |
582 |
$0.00 |
| D0603 |
|
170 |
170 |
$0.00 |