| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,892 |
5,591 |
$290K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,186 |
1,618 |
$209K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,768 |
767 |
$187K |
| D0120 |
Periodic oral evaluation - established patient |
5,724 |
5,452 |
$130K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,803 |
1,094 |
$96K |
| D0272 |
Bitewings - two radiographic images |
5,480 |
5,173 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,201 |
3,975 |
$59K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
993 |
415 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,436 |
1,308 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,711 |
1,626 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
887 |
445 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,502 |
1,496 |
$28K |
| D1110 |
Prophylaxis - adult |
433 |
417 |
$23K |
| D7111 |
|
274 |
170 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
139 |
93 |
$11K |
| D1510 |
|
50 |
37 |
$6K |
| D1351 |
Sealant - per tooth |
228 |
82 |
$4K |
| D2330 |
|
65 |
41 |
$4K |
| D0330 |
Panoramic radiographic image |
41 |
40 |
$3K |
| D2331 |
|
23 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
24 |
$727.35 |