| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
17,797 |
17,797 |
$603K |
| D0120 |
Periodic oral evaluation - established patient |
14,647 |
14,647 |
$332K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,070 |
3,311 |
$264K |
| D1206 |
Topical application of fluoride varnish |
9,469 |
9,469 |
$226K |
| D0220 |
Intraoral - periapical first radiographic image |
14,330 |
14,237 |
$153K |
| D0272 |
Bitewings - two radiographic images |
9,351 |
9,351 |
$119K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,359 |
2,066 |
$109K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,931 |
8,931 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,006 |
4,006 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,133 |
12,126 |
$69K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
830 |
805 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,345 |
1,244 |
$52K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
798 |
776 |
$48K |
| D1354 |
|
1,935 |
938 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
3,230 |
3,203 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,029 |
1,018 |
$31K |
| D0330 |
Panoramic radiographic image |
907 |
907 |
$31K |
| D1110 |
Prophylaxis - adult |
584 |
584 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,029 |
1,029 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
189 |
180 |
$13K |
| D1351 |
Sealant - per tooth |
28 |
18 |
$2K |
| D1999 |
|
108 |
102 |
$0.00 |