| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,052 |
7,512 |
$322K |
| D1206 |
Topical application of fluoride varnish |
7,511 |
6,997 |
$244K |
| D0120 |
Periodic oral evaluation - established patient |
4,795 |
4,502 |
$110K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,347 |
1,026 |
$107K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,199 |
654 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,911 |
5,977 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,599 |
2,412 |
$74K |
| D9248 |
|
580 |
508 |
$47K |
| D0272 |
Bitewings - two radiographic images |
2,893 |
2,695 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
4,413 |
4,088 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,038 |
573 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,541 |
1,417 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,826 |
1,587 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
890 |
830 |
$27K |
| D1351 |
Sealant - per tooth |
1,029 |
173 |
$19K |
| D0330 |
Panoramic radiographic image |
500 |
460 |
$15K |
| D9310 |
|
249 |
239 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
452 |
441 |
$8K |
| D0999 |
Unspecified diagnostic procedure, by report |
188 |
188 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
200 |
200 |
$6K |
| D7962 |
|
52 |
44 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
138 |
85 |
$4K |
| D7961 |
|
51 |
43 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
20 |
13 |
$925.50 |
| D0602 |
|
478 |
422 |
$845.00 |
| D0603 |
|
64 |
53 |
$230.00 |
| D0601 |
|
31 |
30 |
$145.00 |