| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,679 |
12,513 |
$577K |
| D0120 |
Periodic oral evaluation - established patient |
11,489 |
11,367 |
$322K |
| D1351 |
Sealant - per tooth |
12,958 |
2,555 |
$307K |
| D9420 |
|
1,008 |
1,000 |
$299K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,751 |
10,639 |
$251K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,951 |
1,460 |
$174K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,206 |
850 |
$161K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,345 |
488 |
$149K |
| D0330 |
Panoramic radiographic image |
2,654 |
2,637 |
$117K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,425 |
1,323 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,079 |
2,058 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
890 |
664 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
924 |
916 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
919 |
894 |
$41K |
| D1110 |
Prophylaxis - adult |
753 |
746 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,043 |
1,035 |
$34K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,054 |
1,046 |
$31K |
| D2140 |
|
520 |
261 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,270 |
1,265 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
281 |
199 |
$16K |
| D2330 |
|
230 |
139 |
$11K |
| D9310 |
|
390 |
389 |
$7K |
| D0601 |
|
659 |
652 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
149 |
146 |
$3K |
| D0602 |
|
374 |
365 |
$3K |
| D0603 |
|
205 |
202 |
$2K |
| D0191 |
|
49 |
49 |
$480.00 |
| D2940 |
|
45 |
39 |
$405.00 |
| D9110 |
|
13 |
12 |
$110.00 |
| D1330 |
|
6,709 |
6,596 |
$0.00 |
| D3120 |
|
79 |
52 |
$0.00 |