| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,364 |
14,823 |
$502K |
| D0120 |
Periodic oral evaluation - established patient |
20,981 |
19,089 |
$469K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,319 |
2,674 |
$425K |
| D1206 |
Topical application of fluoride varnish |
22,260 |
20,279 |
$422K |
| D9248 |
|
4,095 |
3,366 |
$286K |
| D0272 |
Bitewings - two radiographic images |
15,719 |
14,223 |
$186K |
| D1110 |
Prophylaxis - adult |
4,628 |
4,257 |
$186K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,078 |
1,533 |
$152K |
| D0210 |
Intraoral - complete series of radiographic images |
2,853 |
2,615 |
$145K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,848 |
3,241 |
$101K |
| D1351 |
Sealant - per tooth |
3,380 |
1,379 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,649 |
2,402 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
854 |
563 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
658 |
536 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
448 |
385 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,380 |
1,258 |
$30K |
| D2140 |
|
450 |
379 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,085 |
1,862 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
864 |
792 |
$14K |
| D1354 |
|
956 |
430 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
41 |
32 |
$341.65 |
| D0270 |
|
13 |
12 |
$94.56 |
| D9430 |
|
14 |
12 |
$0.00 |