| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,742 |
11,734 |
$413K |
| D0120 |
Periodic oral evaluation - established patient |
11,885 |
11,882 |
$282K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,706 |
2,736 |
$230K |
| D1351 |
Sealant - per tooth |
3,363 |
1,220 |
$154K |
| D0272 |
Bitewings - two radiographic images |
8,706 |
8,702 |
$118K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,207 |
1,820 |
$110K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,383 |
9,381 |
$109K |
| D1110 |
Prophylaxis - adult |
2,272 |
2,271 |
$106K |
| D1206 |
Topical application of fluoride varnish |
4,279 |
4,279 |
$105K |
| D0220 |
Intraoral - periapical first radiographic image |
7,677 |
7,668 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,068 |
1,608 |
$88K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
851 |
707 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,717 |
1,717 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,330 |
6,321 |
$41K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
551 |
477 |
$37K |
| D0330 |
Panoramic radiographic image |
857 |
857 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,164 |
1,164 |
$27K |
| D7111 |
|
259 |
214 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
212 |
212 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
236 |
236 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
25 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
22 |
22 |
$1K |
| D1354 |
|
49 |
13 |
$735.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$210.88 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
129 |
122 |
$0.00 |