| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,888 |
3,841 |
$192K |
| D9450 |
|
7,262 |
6,683 |
$172K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,184 |
4,133 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
3,768 |
3,717 |
$100K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
944 |
527 |
$99K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
528 |
128 |
$99K |
| D1110 |
Prophylaxis - adult |
1,490 |
1,446 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,367 |
1,340 |
$73K |
| D1351 |
Sealant - per tooth |
1,241 |
376 |
$51K |
| D0272 |
Bitewings - two radiographic images |
1,696 |
1,683 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
355 |
224 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
655 |
635 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,261 |
1,219 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
174 |
74 |
$17K |
| D0330 |
Panoramic radiographic image |
298 |
286 |
$17K |
| D0274 |
Bitewings - four radiographic images |
489 |
482 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
866 |
632 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
348 |
321 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
66 |
27 |
$6K |
| D1354 |
|
370 |
128 |
$5K |
| D9310 |
|
13 |
13 |
$693.00 |
| D3120 |
|
17 |
12 |
$668.00 |
| D1999 |
|
24 |
22 |
$0.00 |