| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
19,661 |
19,429 |
$652K |
| D0120 |
Periodic oral evaluation - established patient |
20,973 |
20,767 |
$473K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,148 |
2,833 |
$444K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36,774 |
22,422 |
$326K |
| D0220 |
Intraoral - periapical first radiographic image |
24,794 |
24,076 |
$257K |
| D1110 |
Prophylaxis - adult |
6,106 |
5,996 |
$242K |
| D1206 |
Topical application of fluoride varnish |
12,578 |
12,452 |
$222K |
| D0330 |
Panoramic radiographic image |
4,918 |
4,802 |
$217K |
| D0272 |
Bitewings - two radiographic images |
11,438 |
11,286 |
$199K |
| D0274 |
Bitewings - four radiographic images |
7,779 |
7,700 |
$195K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,144 |
12,990 |
$194K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,227 |
671 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,398 |
3,340 |
$108K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
437 |
145 |
$44K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,443 |
1,421 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
685 |
433 |
$34K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
530 |
169 |
$29K |
| D1351 |
Sealant - per tooth |
870 |
189 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,616 |
1,569 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
278 |
156 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
253 |
243 |
$8K |
| D0240 |
|
641 |
482 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
178 |
176 |
$4K |
| D2394 |
|
17 |
12 |
$2K |
| D9248 |
|
37 |
37 |
$2K |
| D0707 |
|
123 |
122 |
$954.45 |
| D0701 |
|
16 |
16 |
$522.68 |
| D0350 |
|
14 |
13 |
$17.06 |
| D0602 |
|
7,032 |
6,599 |
$0.00 |
| D0603 |
|
9,042 |
8,496 |
$0.00 |
| D0601 |
|
238 |
230 |
$0.00 |