| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,574 |
4,423 |
$204K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,524 |
1,103 |
$166K |
| D1206 |
Topical application of fluoride varnish |
5,372 |
5,204 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,909 |
2,826 |
$73K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,594 |
1,522 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
2,577 |
2,507 |
$48K |
| D0330 |
Panoramic radiographic image |
1,185 |
1,160 |
$45K |
| D1110 |
Prophylaxis - adult |
814 |
790 |
$37K |
| D1351 |
Sealant - per tooth |
2,410 |
735 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,966 |
1,906 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
700 |
356 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
529 |
323 |
$28K |
| D0274 |
Bitewings - four radiographic images |
710 |
699 |
$19K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
148 |
73 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,501 |
1,398 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
379 |
361 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,373 |
767 |
$9K |
| D9248 |
|
85 |
81 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
73 |
43 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
26 |
$3K |
| D9420 |
|
15 |
12 |
$743.60 |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
24 |
$513.25 |
| D0350 |
|
13 |
12 |
$0.00 |
| D9986 |
|
15 |
13 |
$0.00 |