| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,650 |
14,306 |
$488K |
| D0120 |
Periodic oral evaluation - established patient |
16,298 |
15,958 |
$422K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,921 |
891 |
$375K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,311 |
1,298 |
$181K |
| D0220 |
Intraoral - periapical first radiographic image |
14,527 |
14,109 |
$178K |
| D1110 |
Prophylaxis - adult |
3,358 |
3,296 |
$171K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,684 |
11,555 |
$166K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,540 |
11,637 |
$164K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,596 |
937 |
$158K |
| D0272 |
Bitewings - two radiographic images |
7,063 |
6,883 |
$148K |
| D1351 |
Sealant - per tooth |
5,494 |
1,299 |
$141K |
| D1206 |
Topical application of fluoride varnish |
7,270 |
6,999 |
$114K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,556 |
3,400 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,196 |
729 |
$84K |
| D0330 |
Panoramic radiographic image |
1,604 |
1,571 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,080 |
2,009 |
$66K |
| D0274 |
Bitewings - four radiographic images |
1,567 |
1,545 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
466 |
286 |
$25K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
179 |
71 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
471 |
460 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$800.23 |
| D0603 |
|
15,900 |
15,709 |
$318.59 |
| D0270 |
|
13 |
13 |
$92.53 |