| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
62,083 |
61,523 |
$2.63M |
| D0120 |
Periodic oral evaluation - established patient |
60,068 |
59,441 |
$1.93M |
| D1206 |
Topical application of fluoride varnish |
43,745 |
42,636 |
$1.13M |
| D1208 |
Topical application of fluoride, excluding varnish |
19,966 |
19,547 |
$550K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,934 |
3,570 |
$464K |
| D1351 |
Sealant - per tooth |
12,076 |
3,056 |
$417K |
| D0272 |
Bitewings - two radiographic images |
13,700 |
13,589 |
$407K |
| D0274 |
Bitewings - four radiographic images |
8,509 |
8,413 |
$374K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,714 |
5,556 |
$306K |
| D0330 |
Panoramic radiographic image |
1,907 |
1,881 |
$147K |
| D0140 |
Limited oral evaluation - problem focused |
1,646 |
1,589 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
735 |
727 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
2,497 |
2,420 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
356 |
216 |
$35K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
177 |
102 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
269 |
224 |
$22K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
84 |
50 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
76 |
68 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
95 |
66 |
$9K |
| D1354 |
|
432 |
87 |
$3K |
| D0425 |
|
13 |
13 |
$573.30 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$399.36 |
| D1999 |
|
2,178 |
2,058 |
$0.00 |
| D0415 |
|
26 |
26 |
$0.00 |