| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,904 |
8,243 |
$254K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,943 |
1,261 |
$209K |
| D1206 |
Topical application of fluoride varnish |
9,012 |
8,354 |
$192K |
| D0120 |
Periodic oral evaluation - established patient |
6,343 |
5,986 |
$172K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,557 |
1,043 |
$125K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,292 |
652 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,703 |
3,352 |
$87K |
| D0272 |
Bitewings - two radiographic images |
2,773 |
2,543 |
$49K |
| D0330 |
Panoramic radiographic image |
1,281 |
1,156 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,446 |
1,322 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
901 |
805 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
61 |
61 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
17 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
193 |
158 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
19 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
153 |
136 |
$2K |
| D1110 |
Prophylaxis - adult |
314 |
293 |
$1K |