| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,432 |
6,166 |
$205K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,039 |
885 |
$158K |
| D1351 |
Sealant - per tooth |
6,179 |
1,254 |
$157K |
| D1206 |
Topical application of fluoride varnish |
7,510 |
7,155 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
5,077 |
4,878 |
$114K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
747 |
216 |
$90K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,064 |
515 |
$90K |
| D0240 |
|
4,582 |
4,038 |
$80K |
| D0272 |
Bitewings - two radiographic images |
3,449 |
3,305 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,118 |
2,009 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
770 |
446 |
$54K |
| D1110 |
Prophylaxis - adult |
761 |
721 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
1,064 |
1,002 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
861 |
770 |
$24K |
| D2390 |
|
174 |
70 |
$24K |
| D0330 |
Panoramic radiographic image |
420 |
393 |
$22K |
| D0274 |
Bitewings - four radiographic images |
475 |
449 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
942 |
877 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,036 |
340 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
21 |
13 |
$1K |
| D0191 |
|
12 |
12 |
$0.00 |