| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,660 |
12,560 |
$128K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,012 |
1,504 |
$77K |
| D1206 |
Topical application of fluoride varnish |
15,046 |
14,911 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
11,805 |
11,704 |
$69K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,029 |
377 |
$39K |
| D0274 |
Bitewings - four radiographic images |
5,767 |
5,709 |
$37K |
| D0272 |
Bitewings - two radiographic images |
6,431 |
6,368 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,010 |
1,983 |
$28K |
| D1110 |
Prophylaxis - adult |
1,966 |
1,943 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
977 |
621 |
$22K |
| D0330 |
Panoramic radiographic image |
1,510 |
1,492 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
4,017 |
3,944 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
581 |
358 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
274 |
135 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,204 |
1,195 |
$11K |
| D1351 |
Sealant - per tooth |
1,287 |
452 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,659 |
2,131 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,139 |
1,106 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
513 |
498 |
$5K |
| D9248 |
|
110 |
106 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
53 |
43 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
137 |
137 |
$708.41 |
| D0602 |
|
4,475 |
4,222 |
$0.30 |
| D0603 |
|
1,236 |
1,162 |
$0.00 |
| D0601 |
|
293 |
275 |
$0.00 |