| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,407 |
6,191 |
$118K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,232 |
6,378 |
$106K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,634 |
533 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,015 |
1,118 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,258 |
3,137 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,723 |
6,501 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
8,826 |
7,516 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,557 |
871 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
3,969 |
3,839 |
$48K |
| D1351 |
Sealant - per tooth |
2,286 |
726 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
924 |
481 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,855 |
1,437 |
$20K |
| D1110 |
Prophylaxis - adult |
677 |
645 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
410 |
391 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
344 |
158 |
$10K |
| D0160 |
|
525 |
492 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
492 |
460 |
$6K |
| D2934 |
|
93 |
31 |
$6K |
| D0274 |
Bitewings - four radiographic images |
189 |
183 |
$4K |
| D9248 |
|
157 |
142 |
$3K |
| D0330 |
Panoramic radiographic image |
104 |
94 |
$3K |
| D1354 |
|
415 |
137 |
$2K |
| D0272 |
Bitewings - two radiographic images |
171 |
168 |
$2K |
| D0190 |
|
255 |
213 |
$2K |
| D1206 |
Topical application of fluoride varnish |
85 |
84 |
$2K |
| D2330 |
|
40 |
26 |
$1K |
| D1510 |
|
17 |
14 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
13 |
$482.24 |
| D0601 |
|
101 |
88 |
$0.00 |
| D0350 |
|
109 |
23 |
$0.00 |