| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,122 |
9,804 |
$471K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,883 |
2,517 |
$311K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,679 |
10,346 |
$267K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,555 |
988 |
$264K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,467 |
2,100 |
$177K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,454 |
4,189 |
$157K |
| D0272 |
Bitewings - two radiographic images |
8,825 |
8,465 |
$154K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,277 |
9,920 |
$148K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,377 |
1,111 |
$107K |
| D0330 |
Panoramic radiographic image |
1,599 |
1,518 |
$59K |
| D1110 |
Prophylaxis - adult |
950 |
920 |
$44K |
| D1351 |
Sealant - per tooth |
2,546 |
1,086 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
2,731 |
2,562 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
957 |
932 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,075 |
1,064 |
$18K |
| D9420 |
|
381 |
324 |
$16K |
| D2332 |
|
191 |
90 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,516 |
966 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
116 |
114 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
42 |
25 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
24 |
$2K |
| D9110 |
|
45 |
41 |
$930.23 |