| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
19,285 |
17,756 |
$584K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,076 |
3,458 |
$515K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,357 |
1,546 |
$423K |
| D0120 |
Periodic oral evaluation - established patient |
18,305 |
16,815 |
$396K |
| D1206 |
Topical application of fluoride varnish |
18,341 |
16,813 |
$342K |
| D8670 |
Periodic orthodontic treatment visit |
2,955 |
2,711 |
$252K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,085 |
1,960 |
$225K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,850 |
2,150 |
$200K |
| D0210 |
Intraoral - complete series of radiographic images |
3,312 |
3,069 |
$176K |
| D1110 |
Prophylaxis - adult |
4,163 |
3,826 |
$159K |
| D9248 |
|
1,918 |
1,623 |
$137K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,965 |
4,606 |
$132K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,001 |
4,467 |
$131K |
| D1351 |
Sealant - per tooth |
5,341 |
1,782 |
$128K |
| D0272 |
Bitewings - two radiographic images |
7,610 |
7,011 |
$122K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,412 |
4,128 |
$82K |
| D0274 |
Bitewings - four radiographic images |
2,002 |
1,825 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
1,804 |
1,669 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
3,393 |
3,095 |
$37K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
325 |
110 |
$22K |
| D8660 |
|
347 |
345 |
$14K |
| D0330 |
Panoramic radiographic image |
201 |
187 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
929 |
476 |
$8K |
| D1515 |
|
34 |
14 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
30 |
$3K |
| D2330 |
|
47 |
26 |
$3K |
| D2332 |
|
19 |
13 |
$2K |
| D1999 |
|
4,345 |
3,447 |
$0.00 |