| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
31,618 |
30,964 |
$206K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,080 |
8,426 |
$161K |
| D0120 |
Periodic oral evaluation - established patient |
38,469 |
37,778 |
$152K |
| D1208 |
Topical application of fluoride, excluding varnish |
46,631 |
45,729 |
$140K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,358 |
1,903 |
$102K |
| D0230 |
Intraoral - periapical each additional radiographic image |
47,396 |
42,496 |
$100K |
| D1351 |
Sealant - per tooth |
23,551 |
9,251 |
$99K |
| D0220 |
Intraoral - periapical first radiographic image |
46,147 |
45,161 |
$98K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,469 |
5,842 |
$82K |
| D0274 |
Bitewings - four radiographic images |
17,531 |
17,208 |
$79K |
| D1353 |
|
19,682 |
7,608 |
$78K |
| D0272 |
Bitewings - two radiographic images |
21,602 |
21,179 |
$75K |
| D1110 |
Prophylaxis - adult |
10,275 |
10,125 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,296 |
6,162 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,776 |
1,775 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,933 |
7,780 |
$36K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,084 |
488 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
641 |
531 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
1,798 |
1,748 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
429 |
420 |
$3K |
| D2330 |
|
25 |
12 |
$716.94 |
| D0601 |
|
1,511 |
1,309 |
$0.00 |
| D0602 |
|
1,040 |
955 |
$0.00 |
| D0603 |
|
529 |
456 |
$0.00 |