| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,587 |
6,496 |
$306K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,383 |
655 |
$177K |
| D1206 |
Topical application of fluoride varnish |
6,880 |
6,793 |
$174K |
| D0120 |
Periodic oral evaluation - established patient |
5,554 |
5,476 |
$171K |
| D9248 |
|
902 |
884 |
$165K |
| D7140 |
Extraction, erupted tooth or exposed root |
854 |
460 |
$103K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
517 |
241 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,498 |
1,479 |
$82K |
| D0272 |
Bitewings - two radiographic images |
2,851 |
2,806 |
$45K |
| D0330 |
Panoramic radiographic image |
742 |
730 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
275 |
174 |
$29K |
| D9310 |
|
463 |
454 |
$22K |
| D1110 |
Prophylaxis - adult |
335 |
328 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
350 |
346 |
$16K |
| D1351 |
Sealant - per tooth |
292 |
81 |
$11K |
| D0240 |
|
798 |
785 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
541 |
531 |
$10K |
| D0274 |
Bitewings - four radiographic images |
373 |
363 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
605 |
593 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
30 |
16 |
$2K |
| D3120 |
|
42 |
30 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
84 |
82 |
$1K |
| D9420 |
|
24 |
24 |
$360.00 |