| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,315 |
15,980 |
$579K |
| D0120 |
Periodic oral evaluation - established patient |
19,320 |
18,936 |
$540K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,935 |
3,256 |
$472K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,009 |
2,937 |
$407K |
| D0272 |
Bitewings - two radiographic images |
13,780 |
13,494 |
$303K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,795 |
540 |
$253K |
| D1110 |
Prophylaxis - adult |
4,446 |
4,355 |
$234K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,176 |
12,926 |
$188K |
| D0274 |
Bitewings - four radiographic images |
5,492 |
5,379 |
$172K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,945 |
5,747 |
$149K |
| D1206 |
Topical application of fluoride varnish |
8,203 |
8,005 |
$115K |
| D1351 |
Sealant - per tooth |
3,440 |
882 |
$89K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,040 |
782 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
6,360 |
6,101 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,355 |
1,315 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,629 |
2,940 |
$43K |
| D0330 |
Panoramic radiographic image |
1,074 |
1,036 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
296 |
296 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
726 |
707 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
60 |
50 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
29 |
13 |
$2K |
| D9420 |
|
66 |
64 |
$2K |
| D0603 |
|
24,818 |
24,296 |
$0.00 |
| D0602 |
|
33 |
31 |
$0.00 |