| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
8,911 |
8,099 |
$396K |
| D1120 |
Prophylaxis - child |
7,375 |
6,754 |
$351K |
| D1354 |
|
16,409 |
3,089 |
$181K |
| D0120 |
Periodic oral evaluation - established patient |
5,679 |
5,326 |
$165K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,431 |
1,964 |
$164K |
| D1351 |
Sealant - per tooth |
6,945 |
1,315 |
$128K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,552 |
3,116 |
$91K |
| D0274 |
Bitewings - four radiographic images |
4,702 |
4,267 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,109 |
7,961 |
$84K |
| D1110 |
Prophylaxis - adult |
1,816 |
1,678 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,974 |
1,209 |
$73K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,219 |
3,466 |
$67K |
| D0272 |
Bitewings - two radiographic images |
3,158 |
2,874 |
$56K |
| D0330 |
Panoramic radiographic image |
1,658 |
1,384 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,145 |
1,030 |
$32K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
305 |
93 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,584 |
1,389 |
$22K |
| D4346 |
|
114 |
105 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,592 |
1,524 |
$14K |
| D9210 |
|
1,416 |
1,209 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
197 |
76 |
$11K |
| D7111 |
|
101 |
57 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
66 |
42 |
$4K |
| D4355 |
|
30 |
25 |
$2K |
| D9310 |
|
26 |
24 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
52 |
29 |
$1K |
| D0350 |
|
74 |
65 |
$1K |
| D1353 |
|
86 |
15 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
12 |
$680.47 |
| D3120 |
|
27 |
19 |
$533.00 |
| D9215 |
|
29 |
27 |
$129.15 |
| D0603 |
|
562 |
303 |
$15.00 |