| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,667 |
7,529 |
$397K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,442 |
1,938 |
$226K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,303 |
6,195 |
$179K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,519 |
792 |
$168K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,243 |
3,114 |
$111K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,109 |
1,384 |
$106K |
| D1206 |
Topical application of fluoride varnish |
7,005 |
6,891 |
$101K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,677 |
964 |
$79K |
| D1110 |
Prophylaxis - adult |
1,221 |
1,199 |
$63K |
| D0272 |
Bitewings - two radiographic images |
4,356 |
4,249 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,708 |
2,659 |
$57K |
| D0330 |
Panoramic radiographic image |
1,522 |
1,491 |
$55K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
768 |
489 |
$49K |
| D1351 |
Sealant - per tooth |
2,131 |
750 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,893 |
1,849 |
$27K |
| D2332 |
|
342 |
209 |
$25K |
| D0274 |
Bitewings - four radiographic images |
834 |
816 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
276 |
217 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,991 |
1,907 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
600 |
586 |
$18K |
| D9248 |
|
343 |
338 |
$14K |
| D2330 |
|
163 |
130 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,126 |
620 |
$7K |
| D2335 |
|
29 |
12 |
$2K |
| D1330 |
|
165 |
165 |
$1K |
| D9986 |
|
712 |
649 |
$3.00 |
| D1999 |
|
63 |
63 |
$0.00 |