| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,009 |
15,951 |
$456K |
| D0120 |
Periodic oral evaluation - established patient |
15,828 |
15,765 |
$386K |
| D1206 |
Topical application of fluoride varnish |
16,229 |
16,154 |
$304K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,997 |
2,504 |
$247K |
| D1351 |
Sealant - per tooth |
6,088 |
1,457 |
$156K |
| D0272 |
Bitewings - two radiographic images |
6,506 |
6,472 |
$109K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,844 |
1,298 |
$102K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
604 |
481 |
$63K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,386 |
3,231 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
779 |
554 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,314 |
2,300 |
$48K |
| D0603 |
|
7,215 |
7,157 |
$42K |
| D0330 |
Panoramic radiographic image |
977 |
973 |
$36K |
| D0601 |
|
5,214 |
5,192 |
$32K |
| D1110 |
Prophylaxis - adult |
1,239 |
1,219 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
979 |
963 |
$28K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
426 |
366 |
$25K |
| D0240 |
|
1,339 |
1,119 |
$24K |
| D0274 |
Bitewings - four radiographic images |
754 |
750 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
277 |
277 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,200 |
1,177 |
$10K |
| D0602 |
|
1,451 |
1,447 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
278 |
278 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
462 |
462 |
$5K |
| D9920 |
|
77 |
75 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
29 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
266 |
161 |
$1K |
| D1330 |
|
8,231 |
8,145 |
$0.00 |