| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
20,264 |
19,769 |
$576K |
| D0120 |
Periodic oral evaluation - established patient |
21,741 |
21,188 |
$411K |
| D1208 |
Topical application of fluoride, excluding varnish |
24,447 |
23,803 |
$362K |
| D1999 |
|
16,552 |
15,738 |
$320K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,384 |
2,265 |
$266K |
| D0272 |
Bitewings - two radiographic images |
12,230 |
11,944 |
$204K |
| D0330 |
Panoramic radiographic image |
4,568 |
4,428 |
$204K |
| D1351 |
Sealant - per tooth |
7,532 |
2,314 |
$182K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,533 |
7,011 |
$160K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,395 |
980 |
$139K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,219 |
1,657 |
$139K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,396 |
1,672 |
$127K |
| D1110 |
Prophylaxis - adult |
3,229 |
3,155 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,887 |
3,767 |
$92K |
| D0274 |
Bitewings - four radiographic images |
2,241 |
2,178 |
$47K |
| D0240 |
|
2,615 |
1,330 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,772 |
1,667 |
$46K |
| D1206 |
Topical application of fluoride varnish |
2,307 |
2,263 |
$35K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,302 |
1,272 |
$30K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
391 |
293 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,214 |
1,172 |
$13K |
| D1354 |
|
343 |
160 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
831 |
297 |
$8K |
| D3120 |
|
23 |
17 |
$408.00 |