| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
21,861 |
21,161 |
$901K |
| D0120 |
Periodic oral evaluation - established patient |
20,432 |
19,790 |
$577K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,408 |
20,718 |
$557K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,588 |
3,792 |
$498K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,640 |
6,909 |
$349K |
| D1351 |
Sealant - per tooth |
5,784 |
3,181 |
$331K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,375 |
2,844 |
$197K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,542 |
18,180 |
$192K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,170 |
1,866 |
$137K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,381 |
2,009 |
$126K |
| D0220 |
Intraoral - periapical first radiographic image |
20,622 |
19,654 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,048 |
3,812 |
$91K |
| D1354 |
|
2,750 |
1,672 |
$79K |
| D0274 |
Bitewings - four radiographic images |
2,351 |
2,272 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,153 |
1,006 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,661 |
1,612 |
$30K |
| D0330 |
Panoramic radiographic image |
935 |
893 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,815 |
1,730 |
$18K |
| D1510 |
|
178 |
154 |
$13K |
| D1110 |
Prophylaxis - adult |
34 |
34 |
$1K |
| D9110 |
|
23 |
23 |
$1K |
| D1206 |
Topical application of fluoride varnish |
39 |
39 |
$962.00 |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
28 |
$637.50 |
| D0603 |
|
79 |
77 |
$0.00 |
| D0602 |
|
196 |
182 |
$0.00 |
| D0601 |
|
265 |
236 |
$0.00 |