| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
24,039 |
23,066 |
$915K |
| D0120 |
Periodic oral evaluation - established patient |
20,006 |
19,339 |
$551K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,837 |
993 |
$456K |
| D1206 |
Topical application of fluoride varnish |
22,786 |
21,783 |
$392K |
| D0272 |
Bitewings - two radiographic images |
11,293 |
10,945 |
$216K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,186 |
1,676 |
$206K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,640 |
4,342 |
$171K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,809 |
1,631 |
$155K |
| D1354 |
|
10,646 |
2,999 |
$138K |
| D1351 |
Sealant - per tooth |
6,091 |
1,930 |
$136K |
| D0240 |
|
7,534 |
3,788 |
$125K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,463 |
767 |
$110K |
| D0330 |
Panoramic radiographic image |
2,329 |
2,203 |
$107K |
| D0140 |
Limited oral evaluation - problem focused |
2,982 |
2,736 |
$101K |
| D0603 |
|
18,912 |
18,763 |
$95K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,560 |
3,330 |
$78K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,669 |
2,492 |
$66K |
| D9420 |
|
425 |
373 |
$58K |
| D1110 |
Prophylaxis - adult |
1,744 |
1,718 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
4,186 |
3,987 |
$50K |
| D8660 |
|
314 |
294 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,168 |
1,143 |
$27K |
| D0145 |
Oral evaluation for a patient under three years of age |
406 |
406 |
$15K |
| D0601 |
|
2,720 |
2,716 |
$13K |
| D9920 |
|
10,764 |
10,432 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
54 |
28 |
$4K |
| D0602 |
|
117 |
112 |
$608.00 |
| D1330 |
|
24,854 |
23,884 |
$186.00 |
| D1310 |
|
24,860 |
23,895 |
$150.00 |
| D1320 |
|
1,055 |
1,035 |
$0.00 |
| D0470 |
|
315 |
296 |
$0.00 |
| D9986 |
|
389 |
386 |
$0.00 |