| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
19,037 |
18,713 |
$1.02M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,547 |
1,616 |
$536K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15,173 |
14,865 |
$429K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,770 |
20,386 |
$336K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,538 |
2,271 |
$247K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,340 |
1,599 |
$191K |
| D0330 |
Panoramic radiographic image |
3,380 |
3,328 |
$162K |
| D0272 |
Bitewings - two radiographic images |
6,259 |
6,142 |
$122K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,032 |
2,946 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
4,175 |
4,120 |
$111K |
| D1110 |
Prophylaxis - adult |
1,805 |
1,740 |
$94K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,382 |
847 |
$75K |
| D0274 |
Bitewings - four radiographic images |
1,369 |
1,344 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
1,208 |
1,165 |
$42K |
| D1351 |
Sealant - per tooth |
1,851 |
569 |
$37K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
491 |
237 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,560 |
1,514 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,914 |
400 |
$16K |
| D1510 |
|
112 |
58 |
$11K |
| D9110 |
|
51 |
50 |
$3K |
| D2330 |
|
18 |
12 |
$972.40 |
| D1999 |
|
1,395 |
1,336 |
$0.00 |