| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,337 |
4,333 |
$166K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,668 |
843 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
4,136 |
4,131 |
$103K |
| D1351 |
Sealant - per tooth |
2,799 |
890 |
$99K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,760 |
1,727 |
$83K |
| D1206 |
Topical application of fluoride varnish |
2,583 |
2,579 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,129 |
2,109 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,008 |
556 |
$49K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
390 |
182 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
789 |
433 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,832 |
2,801 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,175 |
2,172 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,559 |
1,558 |
$27K |
| D1110 |
Prophylaxis - adult |
557 |
556 |
$25K |
| D0330 |
Panoramic radiographic image |
561 |
561 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
851 |
847 |
$23K |
| D0274 |
Bitewings - four radiographic images |
622 |
622 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
70 |
38 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
272 |
267 |
$4K |
| D9995 |
|
12 |
12 |
$0.00 |