| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,411 |
6,256 |
$230K |
| D0120 |
Periodic oral evaluation - established patient |
7,667 |
7,521 |
$212K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,078 |
7,910 |
$141K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,371 |
742 |
$85K |
| D1110 |
Prophylaxis - adult |
1,441 |
1,418 |
$69K |
| D1351 |
Sealant - per tooth |
2,805 |
727 |
$66K |
| D0272 |
Bitewings - two radiographic images |
3,154 |
3,058 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,627 |
1,508 |
$39K |
| D1206 |
Topical application of fluoride varnish |
2,221 |
2,118 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,127 |
1,105 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
610 |
313 |
$34K |
| D0603 |
|
5,076 |
4,963 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,307 |
2,204 |
$29K |
| D1354 |
|
2,029 |
550 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
148 |
49 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
371 |
357 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,456 |
1,059 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
325 |
314 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
140 |
69 |
$11K |
| D0602 |
|
1,341 |
1,320 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
75 |
26 |
$7K |
| D9420 |
|
25 |
24 |
$4K |
| D0330 |
Panoramic radiographic image |
74 |
71 |
$4K |
| D0601 |
|
284 |
282 |
$2K |