| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,093 |
12,583 |
$551K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,952 |
13,394 |
$385K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,210 |
1,819 |
$343K |
| D0120 |
Periodic oral evaluation - established patient |
11,660 |
11,243 |
$239K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,000 |
983 |
$170K |
| D1351 |
Sealant - per tooth |
5,093 |
1,738 |
$167K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,758 |
1,132 |
$135K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,883 |
3,384 |
$114K |
| D0272 |
Bitewings - two radiographic images |
3,846 |
3,720 |
$92K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
640 |
180 |
$86K |
| D0140 |
Limited oral evaluation - problem focused |
2,145 |
1,897 |
$71K |
| D0330 |
Panoramic radiographic image |
1,123 |
1,067 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,626 |
1,525 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,543 |
1,508 |
$53K |
| D1110 |
Prophylaxis - adult |
862 |
836 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
1,740 |
1,656 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
551 |
517 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
266 |
248 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
18 |
12 |
$5K |
| D1206 |
Topical application of fluoride varnish |
24 |
24 |
$847.04 |
| D3120 |
|
13 |
12 |
$494.00 |