| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
21,016 |
20,303 |
$703K |
| D0120 |
Periodic oral evaluation - established patient |
22,947 |
22,328 |
$503K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,738 |
2,532 |
$432K |
| D0220 |
Intraoral - periapical first radiographic image |
27,204 |
26,104 |
$279K |
| D0272 |
Bitewings - two radiographic images |
16,681 |
16,012 |
$276K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,028 |
19,422 |
$257K |
| D1110 |
Prophylaxis - adult |
6,414 |
6,203 |
$249K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,525 |
23,271 |
$230K |
| D0330 |
Panoramic radiographic image |
4,956 |
4,706 |
$213K |
| D1206 |
Topical application of fluoride varnish |
8,495 |
8,145 |
$188K |
| D0274 |
Bitewings - four radiographic images |
6,041 |
5,862 |
$158K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,687 |
896 |
$151K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,566 |
4,367 |
$149K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
826 |
308 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
704 |
350 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,942 |
1,830 |
$27K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
807 |
294 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
928 |
786 |
$24K |
| D1351 |
Sealant - per tooth |
857 |
208 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
870 |
836 |
$18K |
| D9248 |
|
120 |
110 |
$6K |
| D0240 |
|
439 |
258 |
$3K |
| D2394 |
|
16 |
12 |
$3K |
| D1354 |
|
179 |
63 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
135 |
53 |
$2K |
| D0707 |
|
153 |
108 |
$970.95 |
| D0210 |
Intraoral - complete series of radiographic images |
357 |
353 |
$499.22 |
| D0350 |
|
90 |
83 |
$280.60 |
| D1999 |
|
33 |
32 |
$69.00 |
| D0602 |
|
10,363 |
9,853 |
$0.00 |
| D0603 |
|
4,970 |
4,503 |
$0.00 |
| D0601 |
|
1,590 |
1,423 |
$0.00 |
| D0709 |
|
12 |
12 |
$0.00 |