| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,807 |
11,507 |
$563K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,958 |
3,085 |
$336K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,859 |
10,569 |
$274K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,858 |
4,626 |
$178K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,553 |
1,065 |
$177K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,147 |
9,868 |
$147K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,302 |
1,683 |
$124K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,113 |
1,362 |
$111K |
| D0272 |
Bitewings - two radiographic images |
4,989 |
4,856 |
$91K |
| D0330 |
Panoramic radiographic image |
2,021 |
1,973 |
$84K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,151 |
816 |
$74K |
| D1351 |
Sealant - per tooth |
3,748 |
1,401 |
$70K |
| D1110 |
Prophylaxis - adult |
1,338 |
1,313 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,566 |
2,527 |
$59K |
| D1206 |
Topical application of fluoride varnish |
2,909 |
2,864 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,333 |
1,298 |
$38K |
| D2332 |
|
467 |
282 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
436 |
373 |
$36K |
| D2330 |
|
406 |
259 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,018 |
1,944 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
618 |
595 |
$19K |
| D2331 |
|
116 |
74 |
$7K |
| D2335 |
|
53 |
25 |
$5K |
| D9420 |
|
54 |
53 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
425 |
265 |
$3K |
| D7111 |
|
38 |
27 |
$2K |
| D1330 |
|
83 |
83 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$271.25 |
| D9986 |
|
5,762 |
4,615 |
$0.00 |