| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
19,454 |
17,732 |
$387K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,159 |
1,231 |
$382K |
| D0120 |
Periodic oral evaluation - established patient |
15,989 |
14,683 |
$277K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,404 |
1,824 |
$275K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,567 |
2,197 |
$246K |
| D1206 |
Topical application of fluoride varnish |
16,033 |
14,357 |
$215K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,762 |
7,001 |
$204K |
| D0240 |
|
17,778 |
7,853 |
$199K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,842 |
1,544 |
$166K |
| D1351 |
Sealant - per tooth |
6,901 |
1,860 |
$144K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,298 |
6,982 |
$139K |
| D0330 |
Panoramic radiographic image |
3,099 |
2,688 |
$122K |
| D1110 |
Prophylaxis - adult |
3,572 |
3,296 |
$122K |
| D0272 |
Bitewings - two radiographic images |
12,212 |
11,188 |
$122K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,092 |
1,151 |
$100K |
| D0274 |
Bitewings - four radiographic images |
3,163 |
2,913 |
$63K |
| D2140 |
|
1,753 |
1,095 |
$63K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
965 |
414 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,406 |
1,291 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
857 |
751 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
895 |
632 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,072 |
1,378 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
3,079 |
2,718 |
$15K |
| D2330 |
|
260 |
143 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
109 |
80 |
$7K |
| D2160 |
|
56 |
37 |
$3K |
| D1354 |
|
55 |
18 |
$2K |
| D0180 |
|
42 |
42 |
$1K |
| D1330 |
|
28 |
28 |
$0.00 |
| D1310 |
|
12 |
12 |
$0.00 |