| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,285 |
4,089 |
$159K |
| D0120 |
Periodic oral evaluation - established patient |
4,788 |
4,580 |
$148K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,357 |
797 |
$147K |
| D1351 |
Sealant - per tooth |
3,101 |
770 |
$99K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,961 |
1,706 |
$75K |
| D1206 |
Topical application of fluoride varnish |
4,017 |
3,878 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
714 |
425 |
$67K |
| D0272 |
Bitewings - two radiographic images |
1,613 |
1,557 |
$42K |
| D1110 |
Prophylaxis - adult |
745 |
737 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
566 |
552 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,217 |
1,144 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
150 |
76 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
36 |
17 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
141 |
138 |
$7K |
| D0274 |
Bitewings - four radiographic images |
172 |
172 |
$6K |
| D0330 |
Panoramic radiographic image |
108 |
103 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
35 |
13 |
$3K |
| D0240 |
|
337 |
171 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
153 |
150 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
12 |
$79.80 |
| D9986 |
|
190 |
189 |
$0.00 |
| D9987 |
|
15 |
15 |
$0.00 |
| D0603 |
|
128 |
126 |
$0.00 |