| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,498 |
6,959 |
$199K |
| D0120 |
Periodic oral evaluation - established patient |
10,107 |
9,434 |
$180K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,137 |
1,416 |
$153K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,218 |
9,540 |
$141K |
| D1351 |
Sealant - per tooth |
4,551 |
1,295 |
$102K |
| D0330 |
Panoramic radiographic image |
2,245 |
2,066 |
$97K |
| D1110 |
Prophylaxis - adult |
2,817 |
2,645 |
$94K |
| D0272 |
Bitewings - two radiographic images |
5,778 |
5,374 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,378 |
952 |
$77K |
| D0240 |
|
3,122 |
1,408 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,688 |
2,445 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,996 |
1,879 |
$42K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
445 |
275 |
$37K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
454 |
288 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
406 |
249 |
$21K |
| D9110 |
|
367 |
329 |
$13K |
| D1206 |
Topical application of fluoride varnish |
463 |
437 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
92 |
76 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
416 |
396 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
320 |
271 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
167 |
123 |
$2K |
| D0350 |
|
23 |
13 |
$0.00 |