| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,930 |
3,675 |
$300.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,995 |
9,038 |
$169.50 |
| D0601 |
|
242 |
206 |
$0.00 |
| D4342 |
|
103 |
49 |
$0.00 |
| D0603 |
|
2,801 |
2,468 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,009 |
4,417 |
$0.00 |
| D0602 |
|
359 |
343 |
$0.00 |
| D1330 |
|
5,563 |
4,861 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
3,826 |
2,434 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,998 |
2,062 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
3,651 |
3,481 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,631 |
1,823 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
3,420 |
3,197 |
$0.00 |
| D1310 |
|
3,549 |
3,155 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
540 |
438 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
195 |
158 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
1,344 |
1,189 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
2,703 |
2,368 |
$0.00 |
| D2160 |
|
238 |
215 |
$0.00 |
| D1351 |
Sealant - per tooth |
2,256 |
709 |
$0.00 |
| D2330 |
|
499 |
340 |
$0.00 |
| D2331 |
|
103 |
85 |
$0.00 |
| D2335 |
|
37 |
27 |
$0.00 |
| D0170 |
|
19 |
15 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
4,123 |
3,928 |
$0.00 |
| D0270 |
|
1,826 |
1,581 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,655 |
1,277 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
142 |
121 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
532 |
498 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
2,401 |
2,143 |
$0.00 |
| D0350 |
|
1,076 |
541 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
199 |
128 |
$0.00 |
| D9430 |
|
1,191 |
1,005 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
902 |
689 |
$0.00 |
| D2332 |
|
334 |
233 |
$0.00 |
| D9993 |
|
3,648 |
3,225 |
$0.00 |
| D1110 |
Prophylaxis - adult |
321 |
257 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,897 |
1,992 |
$0.00 |
| D0330 |
Panoramic radiographic image |
139 |
106 |
$0.00 |
| D1510 |
|
464 |
378 |
$0.00 |
| D2140 |
|
755 |
629 |
$0.00 |
| D4341 |
|
50 |
25 |
$0.00 |