| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
28,620 |
28,378 |
$498K |
| D0120 |
Periodic oral evaluation - established patient |
35,282 |
35,010 |
$402K |
| D1206 |
Topical application of fluoride varnish |
28,822 |
28,613 |
$308K |
| D0274 |
Bitewings - four radiographic images |
20,128 |
19,968 |
$262K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,057 |
3,393 |
$243K |
| D0220 |
Intraoral - periapical first radiographic image |
36,268 |
35,833 |
$210K |
| D1110 |
Prophylaxis - adult |
10,141 |
10,065 |
$210K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,840 |
34,494 |
$171K |
| D0272 |
Bitewings - two radiographic images |
12,116 |
11,991 |
$115K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
771 |
318 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,059 |
2,034 |
$43K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
774 |
317 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,888 |
9,792 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
591 |
330 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
532 |
356 |
$19K |
| D9248 |
|
605 |
591 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
304 |
208 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
629 |
602 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
287 |
285 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
252 |
248 |
$4K |
| D0602 |
|
636 |
560 |
$0.00 |
| D0601 |
|
1,629 |
1,440 |
$0.00 |
| D0603 |
|
17 |
17 |
$0.00 |