| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,361 |
16,114 |
$449K |
| D0120 |
Periodic oral evaluation - established patient |
15,980 |
15,747 |
$321K |
| D1206 |
Topical application of fluoride varnish |
13,232 |
13,025 |
$284K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,154 |
1,528 |
$172K |
| D0272 |
Bitewings - two radiographic images |
8,697 |
8,568 |
$162K |
| D1999 |
|
5,962 |
5,709 |
$116K |
| D0330 |
Panoramic radiographic image |
2,181 |
2,141 |
$101K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,337 |
4,089 |
$87K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,428 |
771 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,562 |
4,497 |
$68K |
| D1110 |
Prophylaxis - adult |
1,814 |
1,770 |
$63K |
| D1351 |
Sealant - per tooth |
1,978 |
647 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,480 |
3,361 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,278 |
1,248 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,004 |
953 |
$26K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
280 |
166 |
$26K |
| D0274 |
Bitewings - four radiographic images |
690 |
680 |
$16K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
141 |
107 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
433 |
419 |
$9K |
| D0240 |
|
490 |
429 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
804 |
633 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
82 |
73 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
107 |
89 |
$7K |
| D1354 |
|
343 |
190 |
$4K |
| D9248 |
|
268 |
262 |
$0.00 |