| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,123 |
8,800 |
$251K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,048 |
1,687 |
$250K |
| D1999 |
|
10,003 |
8,927 |
$193K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,473 |
12,200 |
$180K |
| D0120 |
Periodic oral evaluation - established patient |
8,164 |
8,058 |
$159K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,097 |
1,384 |
$137K |
| D0330 |
Panoramic radiographic image |
2,594 |
2,451 |
$116K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
941 |
607 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,043 |
3,771 |
$97K |
| D0272 |
Bitewings - two radiographic images |
5,468 |
5,253 |
$95K |
| D0220 |
Intraoral - periapical first radiographic image |
6,998 |
6,727 |
$78K |
| D1110 |
Prophylaxis - adult |
2,149 |
2,074 |
$77K |
| D1351 |
Sealant - per tooth |
3,352 |
1,091 |
$76K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,447 |
5,108 |
$55K |
| D0240 |
|
3,050 |
1,621 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
607 |
434 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,299 |
1,253 |
$30K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,274 |
1,195 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,050 |
963 |
$22K |
| D9110 |
|
400 |
381 |
$16K |
| D1206 |
Topical application of fluoride varnish |
934 |
727 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
123 |
93 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
392 |
374 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
61 |
52 |
$5K |
| D1330 |
|
29 |
29 |
$0.00 |
| D0603 |
|
119 |
65 |
$0.00 |