| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,602 |
12,933 |
$399K |
| D0120 |
Periodic oral evaluation - established patient |
11,324 |
10,870 |
$308K |
| D1206 |
Topical application of fluoride varnish |
11,087 |
10,466 |
$268K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,427 |
1,459 |
$183K |
| D1351 |
Sealant - per tooth |
6,102 |
1,167 |
$173K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,213 |
463 |
$155K |
| D0330 |
Panoramic radiographic image |
2,849 |
2,723 |
$130K |
| D0272 |
Bitewings - two radiographic images |
5,555 |
5,233 |
$100K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,028 |
2,792 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
1,530 |
1,382 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
522 |
374 |
$55K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
576 |
219 |
$49K |
| D9248 |
|
1,019 |
944 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,250 |
2,222 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
518 |
314 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,696 |
1,095 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,630 |
2,490 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,032 |
872 |
$30K |
| D0274 |
Bitewings - four radiographic images |
728 |
710 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
102 |
102 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
128 |
127 |
$5K |
| D1110 |
Prophylaxis - adult |
25 |
24 |
$907.00 |
| D9420 |
|
64 |
62 |
$0.00 |