| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,795 |
13,593 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
12,839 |
12,660 |
$63K |
| D1206 |
Topical application of fluoride varnish |
14,662 |
14,457 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,741 |
2,106 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
12,673 |
12,426 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,706 |
2,669 |
$22K |
| D0274 |
Bitewings - four radiographic images |
3,875 |
3,797 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,027 |
7,901 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,254 |
837 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
1,809 |
1,775 |
$18K |
| D0272 |
Bitewings - two radiographic images |
4,322 |
4,274 |
$16K |
| D1110 |
Prophylaxis - adult |
1,888 |
1,854 |
$11K |
| D1351 |
Sealant - per tooth |
2,060 |
729 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,583 |
2,315 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,435 |
1,397 |
$8K |
| D0240 |
|
570 |
447 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
801 |
769 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
575 |
287 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
506 |
244 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
230 |
104 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
183 |
101 |
$899.04 |
| D0330 |
Panoramic radiographic image |
28 |
28 |
$740.00 |
| D2140 |
|
64 |
39 |
$125.32 |
| D1999 |
|
2,267 |
1,757 |
$3.00 |
| D0603 |
|
926 |
858 |
$0.00 |
| D0601 |
|
1,513 |
1,395 |
$0.00 |
| D0602 |
|
977 |
964 |
$0.00 |