| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,205 |
4,007 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
3,541 |
3,388 |
$89K |
| D1206 |
Topical application of fluoride varnish |
4,693 |
4,459 |
$73K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,662 |
1,405 |
$67K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
613 |
307 |
$65K |
| D1351 |
Sealant - per tooth |
2,682 |
714 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,167 |
1,107 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
437 |
256 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,878 |
1,758 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,309 |
1,192 |
$19K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
73 |
35 |
$11K |
| D1110 |
Prophylaxis - adult |
198 |
187 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
678 |
277 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
178 |
165 |
$6K |
| D0330 |
Panoramic radiographic image |
102 |
94 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
25 |
14 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
12 |
$1K |
| D1330 |
|
443 |
428 |
$0.00 |
| D1999 |
|
29 |
28 |
$0.00 |