| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
15,250 |
14,882 |
$726K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,681 |
18,212 |
$502K |
| D1351 |
Sealant - per tooth |
12,560 |
3,372 |
$484K |
| D0120 |
Periodic oral evaluation - established patient |
15,989 |
15,562 |
$435K |
| D0274 |
Bitewings - four radiographic images |
6,618 |
6,433 |
$265K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,434 |
1,295 |
$255K |
| D1110 |
Prophylaxis - adult |
3,950 |
3,837 |
$246K |
| D9450 |
|
10,183 |
9,344 |
$241K |
| D2332 |
|
1,535 |
700 |
$202K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
962 |
466 |
$173K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,940 |
865 |
$170K |
| D0330 |
Panoramic radiographic image |
2,105 |
2,054 |
$169K |
| D0220 |
Intraoral - periapical first radiographic image |
9,057 |
8,685 |
$166K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,187 |
686 |
$144K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,645 |
7,843 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,599 |
1,578 |
$83K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,983 |
3,088 |
$83K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,365 |
1,333 |
$35K |
| D9110 |
|
434 |
407 |
$28K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
296 |
143 |
$28K |
| D2160 |
|
222 |
129 |
$20K |
| D0272 |
Bitewings - two radiographic images |
740 |
712 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
282 |
260 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
61 |
40 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
29 |
$5K |
| D2335 |
|
27 |
12 |
$4K |
| D3120 |
|
63 |
49 |
$2K |
| D2330 |
|
29 |
12 |
$2K |
| D2331 |
|
18 |
12 |
$2K |
| D9420 |
|
26 |
25 |
$300.00 |