| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,068 |
15,928 |
$431K |
| D1206 |
Topical application of fluoride varnish |
18,214 |
18,052 |
$307K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,047 |
2,467 |
$286K |
| D0120 |
Periodic oral evaluation - established patient |
14,826 |
14,686 |
$239K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,153 |
999 |
$235K |
| D1351 |
Sealant - per tooth |
7,975 |
3,014 |
$211K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,165 |
1,997 |
$195K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,666 |
4,522 |
$129K |
| D1110 |
Prophylaxis - adult |
2,615 |
2,587 |
$103K |
| D0272 |
Bitewings - two radiographic images |
6,269 |
6,207 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,236 |
3,209 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
1,941 |
1,853 |
$70K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,098 |
614 |
$68K |
| D1354 |
|
2,574 |
1,363 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,759 |
1,746 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
723 |
391 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
968 |
951 |
$18K |
| D0330 |
Panoramic radiographic image |
530 |
524 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,544 |
1,521 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
391 |
389 |
$4K |
| D2331 |
|
119 |
67 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
213 |
61 |
$2K |
| D9310 |
|
45 |
45 |
$2K |