| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
19,992 |
19,623 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,141 |
3,580 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
20,152 |
19,882 |
$12K |
| D1206 |
Topical application of fluoride varnish |
21,294 |
20,878 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,893 |
17,038 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,201 |
502 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
21,278 |
20,713 |
$8K |
| D2934 |
|
465 |
110 |
$5K |
| D1351 |
Sealant - per tooth |
6,173 |
2,148 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,819 |
2,806 |
$4K |
| D0272 |
Bitewings - two radiographic images |
7,854 |
7,749 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,784 |
1,002 |
$4K |
| D0274 |
Bitewings - four radiographic images |
5,413 |
5,332 |
$3K |
| D3230 |
|
440 |
103 |
$3K |
| D0330 |
Panoramic radiographic image |
1,917 |
1,906 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,483 |
3,353 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
732 |
351 |
$2K |
| D1110 |
Prophylaxis - adult |
3,178 |
3,139 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
1,202 |
1,191 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
510 |
164 |
$2K |
| D9248 |
|
189 |
186 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
311 |
242 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
1,175 |
1,143 |
$1K |
| D1354 |
|
648 |
223 |
$856.92 |
| D0240 |
|
392 |
385 |
$759.10 |
| D0145 |
Oral evaluation for a patient under three years of age |
337 |
330 |
$745.70 |
| D0160 |
|
331 |
327 |
$401.18 |
| D7962 |
|
14 |
12 |
$223.96 |
| D3120 |
|
45 |
25 |
$125.74 |
| D2332 |
|
78 |
41 |
$0.00 |
| D1999 |
|
89 |
86 |
$0.00 |
| D0602 |
|
296 |
296 |
$0.00 |
| D0601 |
|
575 |
571 |
$0.00 |
| D0603 |
|
1,947 |
1,920 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
2,081 |
2,078 |
$0.00 |