| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,321 |
3,043 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
4,126 |
3,755 |
$63K |
| D1206 |
Topical application of fluoride varnish |
3,083 |
2,787 |
$58K |
| D7140 |
Extraction, erupted tooth or exposed root |
861 |
444 |
$44K |
| D1110 |
Prophylaxis - adult |
1,185 |
1,054 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,530 |
1,313 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,442 |
1,317 |
$24K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
118 |
73 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
562 |
519 |
$14K |
| D1351 |
Sealant - per tooth |
535 |
141 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
424 |
370 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,409 |
415 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
857 |
734 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
72 |
50 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
61 |
42 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
75 |
51 |
$3K |
| D9248 |
|
163 |
138 |
$3K |
| D0170 |
|
201 |
183 |
$3K |
| D0330 |
Panoramic radiographic image |
51 |
44 |
$3K |
| D1354 |
|
114 |
40 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
817 |
767 |
$985.16 |
| D7111 |
|
34 |
24 |
$72.25 |
| D8670 |
Periodic orthodontic treatment visit |
30 |
29 |
$0.00 |