| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,172 |
2,816 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,019 |
1,475 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,556 |
1,468 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,655 |
2,169 |
$39K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
298 |
62 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
351 |
89 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,263 |
1,189 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
202 |
70 |
$16K |
| D1206 |
Topical application of fluoride varnish |
392 |
382 |
$11K |
| D0330 |
Panoramic radiographic image |
180 |
172 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
92 |
30 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
480 |
446 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
107 |
100 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
118 |
80 |
$1K |
| D1999 |
|
37 |
33 |
$0.00 |