| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
24,598 |
22,756 |
$1.01M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,164 |
3,137 |
$586K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,045 |
1,396 |
$546K |
| D0120 |
Periodic oral evaluation - established patient |
13,518 |
12,497 |
$424K |
| D1206 |
Topical application of fluoride varnish |
15,722 |
14,462 |
$405K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,988 |
6,447 |
$403K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,973 |
2,116 |
$322K |
| D1351 |
Sealant - per tooth |
7,644 |
2,437 |
$268K |
| D0140 |
Limited oral evaluation - problem focused |
5,484 |
4,965 |
$236K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,615 |
8,052 |
$225K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,034 |
3,345 |
$213K |
| D0272 |
Bitewings - two radiographic images |
7,385 |
6,812 |
$209K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,823 |
1,066 |
$184K |
| D0274 |
Bitewings - four radiographic images |
3,820 |
3,469 |
$160K |
| D0330 |
Panoramic radiographic image |
1,973 |
1,836 |
$148K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,216 |
653 |
$141K |
| D0220 |
Intraoral - periapical first radiographic image |
5,041 |
4,608 |
$86K |
| D7111 |
|
919 |
579 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,663 |
1,287 |
$27K |
| D3110 |
|
241 |
106 |
$24K |
| D2330 |
|
141 |
78 |
$12K |
| D9310 |
|
16 |
14 |
$399.84 |
| D1330 |
|
84 |
83 |
$0.00 |