| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,525 |
4,289 |
$181K |
| D0120 |
Periodic oral evaluation - established patient |
4,795 |
4,516 |
$130K |
| D1351 |
Sealant - per tooth |
1,397 |
747 |
$107K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,794 |
3,595 |
$96K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
870 |
634 |
$60K |
| D0274 |
Bitewings - four radiographic images |
2,044 |
1,886 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
4,192 |
3,835 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,045 |
976 |
$22K |
| D8670 |
Periodic orthodontic treatment visit |
93 |
88 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
453 |
331 |
$20K |
| D1110 |
Prophylaxis - adult |
549 |
520 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,766 |
3,425 |
$14K |
| D4341 |
|
98 |
43 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
878 |
819 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
99 |
83 |
$8K |
| D0272 |
Bitewings - two radiographic images |
776 |
728 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
126 |
92 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
54 |
34 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
192 |
183 |
$5K |
| D0330 |
Panoramic radiographic image |
207 |
188 |
$5K |
| D1206 |
Topical application of fluoride varnish |
178 |
167 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
198 |
183 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
35 |
24 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
15 |
$1K |
| D9110 |
|
24 |
24 |
$1K |
| D9310 |
|
38 |
38 |
$649.80 |
| D2330 |
|
17 |
12 |
$449.80 |
| D1330 |
|
89 |
85 |
$0.00 |