| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,105 |
1,011 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
1,563 |
1,426 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
499 |
220 |
$10K |
| D0272 |
Bitewings - two radiographic images |
1,445 |
1,321 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
320 |
151 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
936 |
861 |
$6K |
| D1110 |
Prophylaxis - adult |
510 |
462 |
$4K |
| D1351 |
Sealant - per tooth |
395 |
90 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
146 |
51 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
563 |
509 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
152 |
136 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
95 |
38 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
135 |
118 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
159 |
133 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
407 |
255 |
$830.73 |
| D1206 |
Topical application of fluoride varnish |
112 |
98 |
$518.60 |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
49 |
38 |
$0.00 |
| D9222 |
|
19 |
17 |
$0.00 |