| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
5,195 |
5,162 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,077 |
1,064 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
2,463 |
2,449 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
894 |
886 |
$0.00 |
| D1351 |
Sealant - per tooth |
2,772 |
780 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
786 |
775 |
$0.00 |
| D0603 |
|
1,443 |
1,437 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
5,798 |
5,767 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
967 |
963 |
$0.00 |
| D0602 |
|
478 |
478 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
48 |
40 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,906 |
1,903 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,085 |
788 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
716 |
514 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
47 |
47 |
$0.00 |
| D1330 |
|
16 |
15 |
$0.00 |
| D1353 |
|
23 |
14 |
$0.00 |
| D0601 |
|
12 |
12 |
$0.00 |
| D9310 |
|
24 |
24 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
85 |
58 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
348 |
348 |
$0.00 |
| D0330 |
Panoramic radiographic image |
86 |
84 |
$0.00 |
| D1120 |
Prophylaxis - child |
5,756 |
5,716 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,605 |
1,596 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
188 |
161 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
2,092 |
2,060 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
597 |
413 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
265 |
263 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,875 |
1,726 |
$0.00 |
| D0270 |
|
47 |
44 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
451 |
247 |
$0.00 |
| D2954 |
|
33 |
29 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
93 |
78 |
$0.00 |