| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
20,469 |
20,302 |
$550K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,946 |
3,453 |
$485K |
| D1206 |
Topical application of fluoride varnish |
23,260 |
23,072 |
$386K |
| D0120 |
Periodic oral evaluation - established patient |
19,523 |
19,359 |
$310K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,568 |
1,246 |
$266K |
| D0240 |
|
17,227 |
8,636 |
$168K |
| D9920 |
|
2,205 |
2,182 |
$139K |
| D0272 |
Bitewings - two radiographic images |
6,336 |
6,275 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,390 |
3,374 |
$91K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,601 |
952 |
$89K |
| D1351 |
Sealant - per tooth |
3,791 |
1,190 |
$86K |
| D1110 |
Prophylaxis - adult |
2,289 |
2,275 |
$78K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,084 |
2,966 |
$66K |
| D2335 |
|
462 |
177 |
$58K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
745 |
353 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
919 |
543 |
$53K |
| D0330 |
Panoramic radiographic image |
1,063 |
1,045 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,882 |
1,842 |
$37K |
| D9994 |
|
8,806 |
8,733 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
295 |
191 |
$30K |
| D9420 |
|
333 |
326 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,188 |
1,173 |
$20K |
| D9310 |
|
144 |
143 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
839 |
833 |
$7K |
| D1354 |
|
160 |
52 |
$4K |
| D3120 |
|
67 |
40 |
$1K |