| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,472 |
9,073 |
$0.00 |
| D1120 |
Prophylaxis - child |
22,802 |
22,671 |
$0.00 |
| D1354 |
|
1,503 |
924 |
$0.00 |
| D0270 |
|
619 |
607 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,443 |
3,815 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,756 |
4,105 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
4,165 |
4,076 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
192 |
192 |
$0.00 |
| D1999 |
|
1,071 |
1,006 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
375 |
375 |
$0.00 |
| D2332 |
|
29 |
26 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
16,461 |
16,340 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
574 |
552 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
9,562 |
9,465 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,713 |
2,632 |
$0.00 |
| D9920 |
|
1,264 |
1,229 |
$0.00 |
| D1351 |
Sealant - per tooth |
5,843 |
2,932 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,942 |
7,317 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,416 |
1,302 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,925 |
4,909 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
11,732 |
11,627 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
1,292 |
1,271 |
$0.00 |
| D9310 |
|
59 |
59 |
$0.00 |
| D0240 |
|
5,098 |
5,028 |
$0.00 |
| D0603 |
|
8,578 |
8,500 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
2,212 |
1,965 |
$0.00 |
| D2335 |
|
123 |
117 |
$0.00 |
| D0602 |
|
127 |
127 |
$0.00 |
| D1310 |
|
80 |
79 |
$0.00 |
| D2330 |
|
40 |
39 |
$0.00 |
| D2331 |
|
27 |
25 |
$0.00 |
| D1320 |
|
80 |
79 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$0.00 |
| D1330 |
|
80 |
79 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
25 |
25 |
$0.00 |