| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,033 |
5,865 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
6,109 |
5,940 |
$96K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,812 |
1,399 |
$92K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
860 |
467 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,401 |
1,046 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,488 |
3,391 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
854 |
573 |
$45K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
733 |
483 |
$44K |
| D1206 |
Topical application of fluoride varnish |
3,049 |
2,984 |
$42K |
| D0272 |
Bitewings - two radiographic images |
3,312 |
3,218 |
$31K |
| D1110 |
Prophylaxis - adult |
891 |
864 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
708 |
697 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
943 |
909 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
3,345 |
3,227 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,070 |
2,885 |
$15K |
| D2330 |
|
34 |
28 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
13 |
$975.00 |