| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
22,521 |
21,995 |
$973K |
| D0120 |
Periodic oral evaluation - established patient |
19,236 |
18,835 |
$635K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,045 |
2,908 |
$505K |
| D1206 |
Topical application of fluoride varnish |
17,134 |
16,807 |
$469K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,623 |
772 |
$292K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,104 |
4,705 |
$284K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,270 |
1,937 |
$270K |
| D0272 |
Bitewings - two radiographic images |
7,836 |
7,673 |
$227K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,510 |
3,378 |
$211K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,819 |
4,656 |
$127K |
| D1351 |
Sealant - per tooth |
3,314 |
1,079 |
$122K |
| D0330 |
Panoramic radiographic image |
1,431 |
1,393 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
1,852 |
1,741 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
488 |
259 |
$49K |
| D0274 |
Bitewings - four radiographic images |
566 |
545 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
958 |
908 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
87 |
65 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
616 |
400 |
$10K |
| D2330 |
|
19 |
12 |
$2K |
| D9310 |
|
19 |
18 |
$599.76 |
| D1999 |
|
30 |
28 |
$0.00 |