| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,045 |
6,927 |
$95K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,037 |
1,428 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
5,980 |
5,898 |
$57K |
| D1206 |
Topical application of fluoride varnish |
7,381 |
7,250 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,609 |
857 |
$26K |
| D1351 |
Sealant - per tooth |
2,897 |
948 |
$22K |
| D0272 |
Bitewings - two radiographic images |
3,250 |
3,174 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,459 |
1,416 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
660 |
341 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,415 |
2,158 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
363 |
170 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
3,214 |
3,079 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,148 |
2,236 |
$10K |
| D1110 |
Prophylaxis - adult |
619 |
607 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
425 |
409 |
$5K |
| D0274 |
Bitewings - four radiographic images |
746 |
727 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
103 |
52 |
$4K |
| D0240 |
|
128 |
113 |
$2K |
| D0330 |
Panoramic radiographic image |
60 |
60 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
13 |
$744.24 |
| D1354 |
|
213 |
66 |
$647.68 |
| D0145 |
Oral evaluation for a patient under three years of age |
39 |
39 |
$126.70 |
| D1999 |
|
611 |
520 |
$11.74 |
| D1330 |
|
15 |
15 |
$0.00 |
| D0603 |
|
188 |
182 |
$0.00 |
| D0601 |
|
66 |
62 |
$0.00 |