| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,410 |
9,945 |
$354K |
| D0120 |
Periodic oral evaluation - established patient |
9,563 |
9,146 |
$263K |
| D1206 |
Topical application of fluoride varnish |
10,422 |
9,958 |
$196K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,725 |
981 |
$187K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,954 |
1,874 |
$168K |
| D1351 |
Sealant - per tooth |
7,473 |
1,636 |
$165K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,497 |
3,895 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,852 |
1,763 |
$53K |
| D0272 |
Bitewings - two radiographic images |
4,054 |
3,876 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
827 |
503 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
792 |
565 |
$38K |
| D0330 |
Panoramic radiographic image |
1,077 |
1,037 |
$34K |
| D1110 |
Prophylaxis - adult |
1,238 |
1,202 |
$30K |
| D0603 |
|
2,388 |
2,221 |
$17K |
| D0274 |
Bitewings - four radiographic images |
1,021 |
990 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,925 |
1,816 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
125 |
82 |
$6K |
| D0602 |
|
1,058 |
938 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,242 |
1,038 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
290 |
287 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
150 |
137 |
$4K |
| D0601 |
|
572 |
506 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
46 |
45 |
$3K |
| D1354 |
|
47 |
12 |
$210.00 |
| D1330 |
|
3,960 |
3,593 |
$0.00 |
| D9215 |
|
124 |
116 |
$0.00 |