| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,366 |
4,197 |
$190K |
| D1120 |
Prophylaxis - child |
3,169 |
3,051 |
$186K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,030 |
187 |
$178K |
| D1110 |
Prophylaxis - adult |
1,203 |
1,139 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,994 |
2,878 |
$81K |
| D1351 |
Sealant - per tooth |
1,701 |
403 |
$72K |
| D0272 |
Bitewings - two radiographic images |
1,601 |
1,536 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
481 |
143 |
$58K |
| D1206 |
Topical application of fluoride varnish |
1,336 |
1,266 |
$35K |
| D0274 |
Bitewings - four radiographic images |
323 |
307 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
120 |
39 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
262 |
216 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
151 |
147 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
61 |
40 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
61 |
38 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
204 |
183 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
105 |
64 |
$2K |
| D9310 |
|
15 |
13 |
$1K |